Healthcare Provider Details

I. General information

NPI: 1639170699
Provider Name (Legal Business Name): LAKESIDE WOMEN'S HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 N PORTLAND AVE
OKLAHOMA CITY OK
73120-5045
US

IV. Provider business mailing address

PO BOX 200724
DALLAS TX
75320-0724
US

V. Phone/Fax

Practice location:
  • Phone: 405-986-1500
  • Fax: 405-936-1579
Mailing address:
  • Phone: 405-252-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2339
License Number StateOK

VIII. Authorized Official

Name: MR. BRENT HUBBARD
Title or Position: MANAGER
Credential:
Phone: 405-679-5959