NPIMap

Organization Active NPI

Shadow Mountain Behavioral Health System, LLC

  • Psychiatric Hospital
  • Tulsa, OK
National Provider Identifier
1902224801
Registry record updated Mar 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
2240 Issued in OK
Legal business name
SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC
Practice address
6262 S Sheridan Rd
Tulsa, OK 74133-4055
Phone
(918) 492-8200
NPI assigned
Mar 29, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2014

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 2240 OK Primary

Addresses

Primary practice location

6262 S Sheridan Rd
Tulsa, OK 74133-4055

Mailing address

6262 S Sheridan Rd
Tulsa, OK 74133-4055
Phone (918) 492-8200

Other identifiers 1

IdentifierTypeStateIssuer
2240OtherOKHOSPITAL LICENSE NUMBER

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": "1396051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396051200000",
    "number": "1902224801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6262 S SHERIDAN RD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334055",
            "telephone_number": "918-492-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6262 S SHERIDAN RD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334055",
            "telephone_number": "918-492-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADOW MOUNTAIN BEHAVIORAL HEALTH SYSTEM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-29",
        "last_updated": "2014-03-29",
        "status": "A",
        "authorized_official_last_name": "KISTLER",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-492-8200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "OK",
            "license": "2240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOSPITAL LICENSE NUMBER",
            "identifier": "2240",
            "state": "OK"
        }
    ],
    "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 Mar 29, 2014; 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.