NPIMap

Organization Active NPI

Shadow Mountain Behavioral Health System

  • Foster Care Agency
  • Tulsa, OK
National Provider Identifier
1710275201
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foster Care AgencyTaxonomy code 253J00000X
License
4073 Issued in OK
Legal business name
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM
Practice address
1013 E 66TH PL
Tulsa, OK 74136-3701
Phone
(918) 293-2500
Fax
(918) 492-2075
NPI assigned
Jul 18, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

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
Foster Care Agency 253J00000X 4073 OK Primary

Addresses

Primary practice location

1013 E 66TH PL
Tulsa, OK 74136-3701

Mailing address

1013 E 66TH PL
Tulsa, OK 74136-3701
Phone (918) 293-2500

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

NPI Registry JSON

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1710275201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1013 E 66TH PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363701",
            "telephone_number": "918-293-2500",
            "fax_number": "918-492-2075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 E 66TH PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363701",
            "telephone_number": "918-293-2500",
            "fax_number": "918-492-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-18",
        "last_updated": "2011-07-18",
        "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": "253J00000X",
            "taxonomy_group": "",
            "desc": "Foster Care Agency",
            "state": "OK",
            "license": "4073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jul 18, 2011; 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.