=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639170699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKESIDE WOMEN'S HOSPITAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 09/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11200 N PORTLAND AVE
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-5045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-986-1500
-----------------------------------------------------
Fax | 405-936-1579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 200724
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75320-0724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-252-8400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. BRENT HUBBARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-679-5959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 2339
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------