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NPI Code Detail

MEDICARE: LAKESIDE WOMEN'S HOSPITAL, LLC

MEDICARE: LAKESIDE WOMEN'S HOSPITAL, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital2339OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000370199001OTHEROKBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639170699
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESIDE WOMEN'S HOSPITAL, LLC
Provider Business Mailing Address
First Line : PO BOX 200724
Second Line :
City : DALLAS
State : TX
Zip : 75320-0724
Country : US
Telephone Number : 405-252-8400
Fax Number :
Provider Business Practice Location Address
First Line : 11200 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-5045
Country : US
Telephone Number : 405-986-1500
Fax Number : 405-936-1579
Authorized Official
Title or Position : MANAGER
Name : MR. BRENT HUBBARD
Credential :
Telephone Number : 405-679-5959
Provider Enumeration Date : 08/02/2005
Last Update Date : 09/10/2025

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Directions to “LAKESIDE WOMEN'S HOSPITAL, LLC ” Practice Location

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