Provider Demographics
NPI:1972773448
Name:CLAREMORE INDIAN HOSPITAL
Entity Type:Organization
Organization Name:CLAREMORE INDIAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALLIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-342-6200
Mailing Address - Street 1:PO BOX 95431
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-0033
Mailing Address - Country:US
Mailing Address - Phone:918-342-6200
Mailing Address - Fax:918-342-6248
Practice Address - Street 1:101 SOUTH MOORE AVENUE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017
Practice Address - Country:US
Practice Address - Phone:918-342-6200
Practice Address - Fax:918-342-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKAC0011Medicare PIN