Alva Health and Wellness PLLC
Organization Active NPI Family Medicine Physician · Alva, OK
NPI 1134827660 · NPPES record last updated Apr 24, 2023
Key facts
- NPI
- 1134827660
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ALVA HEALTH AND WELLNESS PLLC
- Practice address
- 515 College Ave Ste 3
Alva, OK 73717-2230 - Phone
- (580) 747-0296
- NPI assigned
- Feb 23, 2023
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeremy D Logsdon, APRN
- Title
- Lead Provider
- Phone
- (580) 747-0296
Practitioners 1
-
Jeremy D Logsdon, CNP- FAMILY
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 37D2277773 | Alva Health and Wellness | Certificate of waiver | Mar 5, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230424000638 | OK | Part B Supplier - Clinic/Group Practice | 4486019627 |
Receives reassigned benefits from 1 practitioner Practice locations: Alva, OK |
National Provider Directory
Locations
515 College Ave
Ste 3
Alva, OK 73717
Phone (580) 747-0296
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
515 College Ave Ste 3
Alva, OK 73717-2230
Mailing address
515 College Ave Ste 3
Alva, OK 73717-2230
Phone (580) 747-0296
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200851950A | Medicaid | OK |
Other providers in Alva, OK
- Kay Albitz
- Alva Chiropractic Clinic, P.L.L.C.
- Alva EMS
- Alva Hospital Authority
- Alva Hospital Authority
- Alva Hospital Authority
- Alva Hospital Authority
- Alva Hospital Authority
All providers in Alva, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.