Provider Demographics
NPI:1982683306
Name:VALIR OUTPATIENT CLINICS LLC
Entity Type:Organization
Organization Name:VALIR OUTPATIENT CLINICS LLC
Other - Org Name:VALIR OUTPATIENT CLINICS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-609-3667
Mailing Address - Street 1:800 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7241
Mailing Address - Country:US
Mailing Address - Phone:405-609-3667
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:700 NW 7TH ST
Practice Address - Street 2:STE 302
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1212
Practice Address - Country:US
Practice Address - Phone:405-609-3675
Practice Address - Fax:800-506-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200051680AMedicaid
OK200051680AMedicaid