Provider Demographics
NPI:1679684682
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:580-430-3332
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:580-430-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-08-02
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-02-28
Provider Licenses
StateLicense IDTaxonomies
275N00000X, 282NC0060X
OK2251282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699830FMedicaid
OK37-1341Medicaid
KS100099810AMedicaid
000370080001OtherBLUE CROSS
OK100699830KMedicaid
OK100699830AMedicaid
MO015225105Medicaid
OK37-Z341Medicaid
OK100699830FMedicaid
=========7371OtherCHAMPUS
=========OtherCOMMERCIAL INSURANCES