Provider Demographics
NPI:1245765536
Name:VALIR OUTPATIENT CLINICS LLC
Entity type:Organization
Organization Name:VALIR OUTPATIENT CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-609-3600
Mailing Address - Street 1:PO BOX 643001
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264-3001
Mailing Address - Country:US
Mailing Address - Phone:405-553-1197
Mailing Address - Fax:800-506-3795
Practice Address - Street 1:4901 N KICKAPOO AVE STE 1556
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1308
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:2017-04-25
Last Update Date:2023-06-13
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
OK200051680GMedicaid
OK900522245Medicare PIN