1679684682 NPI number — ALVA HOSPITAL AUTHORITY

Table of content: (NPI 1679684682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679684682 NPI number — ALVA HOSPITAL AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALVA HOSPITAL AUTHORITY
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:
SHARE MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1679684682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/25/2020
NPI Reactivation Date:
02/28/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 SHARE DR
Provider Second Line Business Mailing Address:
PO BOX 727
Provider Business Mailing Address City Name:
ALVA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73717-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-327-2800
Provider Business Mailing Address Fax Number:
580-430-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 SHARE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALVA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73717-3618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-327-2800
Provider Business Practice Location Address Fax Number:
580-430-3332
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
KANDICE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
580-430-3309

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NR1301X , with the licence number: 2251 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100699830F , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37-1341 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100099810A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000370080001 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100699830K , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100699830A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015225105 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37-Z341 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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