Provider Demographics
NPI:1497945851
Name:ALVA HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:ALVA HOSPITAL AUTHORITY
Other - Org Name:SMC DOWNTOWN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-327-2800
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:580-430-3366
Mailing Address - Fax:580-430-3365
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:580-430-3375
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-31
Last Update Date:2022-07-21
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-02-28
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherMC PTAN