1710985064 NPI number — LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC

Table of content: (NPI 1710985064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710985064 NPI number — LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710985064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 707001
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74170-7001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-502-8000
Provider Business Mailing Address Fax Number:
918-502-8002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6655 S YALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-3326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-481-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STOLHAND
Authorized Official First Name:
ANDRIA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, PATIENT FINANCIAL SERVICE
Authorized Official Telephone Number:
918-502-8000

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100700380C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100700380D . This is a "MEDICAID DVSD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100700380N . This is a "MEDICAID 1500" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100700380B . This is a "MEDICAID INPATIENT" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: CC6784 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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