Provider Demographics
NPI:1619402237
Name:VALIR OUTPATIENT CLINC #4 LLC
Entity Type:Organization
Organization Name:VALIR OUTPATIENT CLINC #4 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:SAVANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-609-3600
Mailing Address - Street 1:700 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1212
Mailing Address - Country:US
Mailing Address - Phone:405-609-3600
Mailing Address - Fax:
Practice Address - Street 1:1726 S DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-6022
Practice Address - Country:US
Practice Address - Phone:405-293-6138
Practice Address - Fax:405-293-6252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2020-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200051680JMedicaid
OK200051680JMedicaid