Provider Demographics
NPI:1124028675
Name:VALIR HEALTH LLC
Entity Type:Organization
Organization Name:VALIR HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KITT
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-609-3641
Mailing Address - Street 1:825 N BROADWAY AVE
Mailing Address - Street 2:SUITE #400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-6012
Mailing Address - Country:US
Mailing Address - Phone:405-609-3600
Mailing Address - Fax:405-605-8634
Practice Address - Street 1:3700 N KICKAPOO AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1707
Practice Address - Country:US
Practice Address - Phone:405-214-9808
Practice Address - Fax:405-214-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7648261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100745870BMedicaid
OK100745870BMedicaid