Provider Demographics
NPI:1104410125
Name:ALVA HOSPITAL AUTHORITY/DBA SHARE MEDICAL CENTER
Entity type:Organization
Organization Name:ALVA HOSPITAL AUTHORITY/DBA SHARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-430-3309
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:OK
Mailing Address - Zip Code:73717-0727
Mailing Address - Country:US
Mailing Address - Phone:580-327-2800
Mailing Address - Fax:580-430-3374
Practice Address - Street 1:1630 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:WAYNOKA
Practice Address - State:OK
Practice Address - Zip Code:73860-3946
Practice Address - Country:US
Practice Address - Phone:580-327-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALVA HOSPITAL AUTHORITY/DBA SHARE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center