Provider Demographics
NPI:1144534603
Name:ALVA HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:ALVA HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-430-3309
Mailing Address - Street 1:800 SHARE DR
Mailing Address - Street 2:PO BOX 727
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-3618
Mailing Address - Country:US
Mailing Address - Phone:580-327-2800
Mailing Address - Fax:
Practice Address - Street 1:800 SHARE DR
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-3618
Practice Address - Country:US
Practice Address - Phone:580-327-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALVA HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-27
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25482103T00000X, 207R00000X
261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200307510AMedicaid
OK200307510AMedicaid