NPIMap

Organization Active NPI

Alva Hospital Authority/Dba Share Medical Center

  • Clinic/Center
  • Waynoka, OK
National Provider Identifier
1104410125
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ALVA HOSPITAL AUTHORITY/DBA SHARE MEDICAL CENTER
Practice address
1630 Santa Fe St
Waynoka, OK 73860-3946
Phone
(580) 327-2800
NPI assigned
Feb 22, 2021
Last updated
Feb 22, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ALVA HOSPITAL AUTHORITY/DBA SHARE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kandice Allen
Title
Ceo
Phone
(580) 430-3309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1630 Santa Fe St
Waynoka, OK 73860-3946

Mailing address

PO Box 727
Alva, OK 73717-0727
Phone (580) 327-2800

Other names 1

  • SMC MEDICAL CLINIC Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040514000014 OK Part B Supplier - Clinic/Group Practice 5597755306 Receives reassigned benefits from 26 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alva, OK

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Share Medical Center

Locations

410 4th St
Alva, OK 73717
Phone (580) 327-2800

410 4th St
Ste D
Alva, OK 73717
Phone (580) 327-3335

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1104410125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 727",
            "city": "ALVA",
            "state": "OK",
            "postal_code": "737170727",
            "telephone_number": "580-327-2800",
            "fax_number": "580-430-3374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 SANTA FE ST",
            "city": "WAYNOKA",
            "state": "OK",
            "postal_code": "738603946",
            "telephone_number": "580-327-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALVA HOSPITAL AUTHORITY/DBA SHARE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALVA HOSPITAL AUTHORITY/DBA SHARE MEDICAL CENTER",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "KANDICE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "580-430-3309"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMC MEDICAL CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waynoka, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.