| Parkside Outpatient | |
|
1620 E 12th St Tulsa OK 74120-5407 | |
| (918) 582-2131 | |
| Not Available |
| Full Name | Parkside Outpatient |
|---|---|
| Speciality | Psychiatric Hospital |
| Location | 1620 E 12th St, Tulsa, Oklahoma |
| Authorized Official Name and Position | Saunya D Moore (CFO) |
| Authorized Official Contact | 9185822131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Parkside Outpatient 1620 E 12th St Tulsa OK 74120-5407 Ph: (918) 582-2131 | Parkside Outpatient 1620 E 12th St Tulsa OK 74120-5407 Ph: (918) 582-2131 |
| NPI Number | 1851327464 |
|---|---|
| Provider Enumeration Date | 06/24/2006 |
| Last Update Date | 10/31/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851327464 | NPI | - | NPPES |
| 100738360B | Medicaid | OK | |
| A00174120 | Other | OK | CHAMPUS |
| 000374005-001 | Other | OK | BC/BS |
| 100738360C | Medicaid | OK |
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