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

General Provider Information

NPI Number	:	1326396391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE, INC.

Provider Business Mailing Address
First Line	:	1620 E 12TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-5407
Country	:	US
Telephone Number	:	918-586-4250
Fax Number	:	918-586-4203

Provider Business Practice Location Address
First Line	:	1220 S TRENTON AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74120-5421
Country	:	US
Telephone Number	:	918-586-4250
Fax Number	:	918-586-4203

Authorized Official
Title or Position	:	CFO
Name	:	MRS. SAUNYA D. MOORE
Credential	:
Telephone Number	:	918-588-8874

Provider Enumeration Date	:	08/24/2012
Last Update Date	:	11/14/2012

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Directions to “PARKSIDE, INC. ” Practice Location

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