Provider Demographics
NPI:1588962989
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:
Authorized Official - Last Name:VALLIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-342-6200
Mailing Address - Street 1:PO BOX 676735
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-6735
Mailing Address - Country:US
Mailing Address - Phone:918-342-6200
Mailing Address - Fax:918-342-6436
Practice Address - Street 1:101 S MOORE AVE
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-5047
Practice Address - Country:US
Practice Address - Phone:918-342-6200
Practice Address - Fax:918-342-6436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLAREMORE INDIAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700620MMedicaid