NPIMap

Organization Active NPI

Shadow Mountain Behavioral Health System LLC

Doing business as Shadow Mountain Behavioral Health System Pharmacy

  • Psychiatric Residential Treatment Facility
  • Tulsa, OK
National Provider Identifier
1316091457
Registry record updated Mar 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
K8500227 Issued in OK
Legal business name
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC
Doing business as
Shadow Mountain Behavioral Health System Pharmacy
Practice address
1027 E 66TH PL
Tulsa, OK 74136-3701
Phone
(918) 293-2552
NPI assigned
Jan 23, 2007
Last updated
Mar 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mike Kistler
Title
Ceo
Phone
(918) 492-8200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X K8500227 OK Primary

Addresses

Primary practice location

1027 E 66TH PL
Tulsa, OK 74136-3701

Mailing address

1027 E 66TH PL
Tulsa, OK 74136-3701
Phone (918) 293-2552

Other identifiers 1

IdentifierTypeStateIssuer
200006820QMedicaidOK

Other names 1

  • Shadow Mountain Behavioral Health System Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shadow Mountain Behavioral Health System15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Locations

1027 E 66th Pl
Tulsa, OK 74136
Phone (918) 492-8200

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269907200000",
    "number": "1316091457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1027 E 66TH PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363701",
            "telephone_number": "918-293-2552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1027 E 66TH PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363701",
            "telephone_number": "918-293-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2010-03-30",
        "status": "A",
        "authorized_official_last_name": "KISTLER",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-492-8200"
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "OK",
            "license": "K8500227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200006820Q",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shadow Mountain Behavioral Health System Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.