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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	2261	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	374021	OTHER	OK	MEDICARE PROVIDER NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1548573348
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	:	918-582-2131
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	:	918-582-2131
Fax Number	:	918-588-8822

Authorized Official
Title or Position	:	CFO
Name	:	MRS. SAUNYA D. MOORE
Credential	:
Telephone Number	:	918-582-2131

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	10/31/2012

Similar Medicare Providers

1205135936 — PARKSIDE, INC.
Practice Location Address:

1220 S TRENTON AVE
TULSA, OK
74120-5421

Practice Phone: 918-588-8874
Practice Fax:

1164643409 — PARKSIDE, INC.
Practice Location Address:

1220 S TRENTON AVE
TULSA, OK
74120-5421

Practice Phone: 918-582-2131
Practice Fax:

1326396391 — PARKSIDE, INC.
Practice Location Address:

1220 S TRENTON AVE
TULSA, OK
74120-5421

Practice Phone: 918-586-4250
Practice Fax: 918-586-4203

1508612151 — BAILEY MITCHELL TRS
Practice Location Address:

1239 S TRENTON AVE
TULSA, OK
74120-5420

Practice Phone: 918-588-8807
Practice Fax: 918-588-8822

1346461688 — PARKSIDE, INC.
Practice Location Address:

1239 S TRENTON AVE
TULSA, OK
74120-5420

Practice Phone: 918-588-8888
Practice Fax: 918-588-8859

1467311506 — ALEXIS YOUNG
Practice Location Address:

101 N GREENWOOD AVE STE 131
TULSA, OK
74120-1444

Practice Phone: 918-599-7277
Practice Fax:

Directions to “PARKSIDE, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.