MEDICARE: PARKSIDE, INC.

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
1	283Q00000X	Psychiatric Hospital
2	273R00000X	Psychiatric Hospital Unit	2261	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205135936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE, INC.

Provider Business Mailing Address
First Line	:	1239 S TRENTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-5420
Country	:	US
Telephone Number	:	918-582-2131
Fax Number	:	918-588-8822

Provider Business Practice Location Address
First Line	:	1220 S TRENTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-5421
Country	:	US
Telephone Number	:	918-588-8874
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS DEVELOPMENT
Name	:	MR. WILLIAM ERIC SACHAU
Credential	:
Telephone Number	:	918-588-8826

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	05/26/2026

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Directions to “PARKSIDE, INC. ” Practice Location

Language	Start Address	Practice Location

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