Organization
PARKSIDE, INC.
Active
Other names
Parkside Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SAUNYA D MOORE (CFO)
(918) 582-2131
Entity
Organization
Contact information
Practice address
1620 E 12TH ST, TULSA, OK 74120-5407
(918) 582-2131
Mailing address
1620 E 12TH ST, TULSA, OK 74120-5407
(918) 582-2131
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
2261
OK
261QM0855X
Adolescent and Children Mental Health Clinic/Center
2261
OK
283Q00000X
Psychiatric Hospital
Primary
2261
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000374005-001
BC/BS
OK
05
—
100738360B
—
OK
05
—
100738360C
—
OK
01
—
A00174120
CHAMPUS
OK
Enumeration date
06/24/2006
Last updated
10/31/2012
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