Organization
LAKESIDE WOMEN'S HOSPITAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT HUBBARD (MANAGER)
(405) 679-5959
Entity
Organization
Contact information
Practice address
11200 N PORTLAND AVE, OKLAHOMA CITY, OK 73120-5045
(405) 986-1500
(405) 936-1579
Mailing address
PO BOX 200724, DALLAS, TX 75320-0724
(405) 252-8400
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
2339
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000370199001
BCBS
OK
05
—
100745350A
—
OK
05
—
100745350B
—
OK
Enumeration date
08/02/2005
Last updated
09/10/2025
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