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Organization

LAKESIDE WOMEN'S CENTER OF OKLAHOMA CITY, LLC

Active
Parent organization
LAKESIDE WOMEN'S CENTER OF OKLAHOMA CITY, LLC
Other names
Lakeside Physician Group
Organization subpart
Yes

Provider details

NPI number
Legal business name
LAKESIDE WOMEN'S CENTER OF OKLAHOMA CITY, LLC
Authorized official
DARLA MCCALLISTER (CFO)
(405) 936-1554
Entity
Organization

Contact information

Practice address
11200 N PORTLAND AVE, OKLAHOMA CITY, OK 73120-5045
(405) 936-1500
(405) 418-0524
Mailing address
PO BOX 8387, BELFAST, ME 04915-8300
(405) 936-1577
(866) 354-4053

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000370199001
BCBS
OK
05
100745350C
OK
Enumeration date
03/10/2011
Last updated
02/24/2012
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