Provider Demographics
NPI:1447413422
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:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-3618
Mailing Address - Country:US
Mailing Address - Phone:580-430-3345
Mailing Address - Fax:580-430-3348
Practice Address - Street 1:410 4TH ST STE J
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-2363
Practice Address - Country:US
Practice Address - Phone:580-430-3333
Practice Address - Fax:580-430-3333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALVA HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-09
Last Update Date:2025-07-18
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-07-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200182150AMedicaid
OK200182150AMedicaid