NPIMap

Organization Active NPI

Integris Canadian Valley Hospital

  • General Acute Care Hospital
  • Yukon, OK
National Provider Identifier
1306865357
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
2343 Issued in OK
Legal business name
INTEGRIS CANADIAN VALLEY HOSPITAL
Doing business as
Integris Canadian Valley Hospital
Practice address
1201 Health Center Pkwy
Yukon, OK 73099-6381
Phone
(405) 717-6800
NPI assigned
Jul 19, 2006
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Donna Wallace
Title
Assistant Treasurer
Phone
(636) 359-4890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 2343 OK Primary

Addresses

Primary practice location

1201 Health Center Pkwy
Yukon, OK 73099-6381

Mailing address

PO Box 200173
Dallas, TX 75320-0173
Phone (405) 252-8400

Other identifiers 1

IdentifierTypeStateIssuer
100700610AMedicaidOK

Other names 1

  • Integris Canadian Valley Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address INTEGRIS@DIRECT.INTEGRISOK.COM Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041203000689 OK Part A Provider - Hospital 8628968286 Practice locations: Yukon, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306865357. Details of each certification follow.

Hospital certification: CCN 370211

Legal name
INTEGRIS CANADIAN VALLEY HOSPITAL
Doing business as
INTEGRIS CANADIAN VALLEY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Nov 30, 2001
Last certification
Apr 3, 2025
Beds
75 (44 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 14, 1994 in OK
Enrollment address
1201 Health Center Pkwy
Yukon, OK 73099-6381
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Integris Canadian Valley HospitalCCN 370211 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
John a Alberts Individual Corporate Director Jul 1, 2024
John R Gassen Individual Corporate Officer Jul 1, 2024
Corporate Director Jul 1, 2023
Donna M Wallace Individual Corporate Officer Dec 19, 2023
Howard Lester Wald Individual Corporate Director Jul 1, 2017
Michael Gray Individual Corporate Director Jul 1, 2023
Nancy N Nagle Individual Corporate OfficerCmo Sep 1, 2023
Michael L Weed Individual Corporate Officer Jan 1, 2023
Jill Huff Individual Corporate Director Jul 1, 2022
Casey Ahlden Individual Corporate Officer Jan 1, 2023
Integris Health Inc Organization, Oklahoma City, OK Corporation, Non-profit Operational/Managerial Control Nov 9, 2001
Gayla Lutts Individual Corporate Officer Jul 1, 2023
Corporate Director Jul 1, 2018
Brent Hubbard Individual Corporate Officer Jul 1, 2022
Corporate Director Jul 1, 2022
Jena L Marr Individual Corporate Director Jul 1, 2024
Jacob Cyrus Carman Individual Corporate OfficerMedical Staff President Jul 1, 2023
Corporate DirectorMedical Staff President Jul 1, 2023
Christy Stanley Individual Corporate Officer Jul 1, 2023
Corporate Director Jul 1, 2020
Integris Rural Health Inc Organization, Oklahoma City, OK Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 9, 2001 100%
Operational/Managerial Control Nov 9, 2001 100%
Teresa L Gray Individual Contracted Managing EmployeeChe Jul 5, 2020
Corporate OfficerChe Jul 5, 2020
Operational/Managerial ControlChe Jul 5, 2020
Raymond Wright Individual Corporate Director Nov 1, 2001
Timothy Pehrson Individual OtherChain Home Office Administrator Aug 1, 2018

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Practitioners & affiliated clinicians

Practitioners 58

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 58

Affiliated clinicians 355

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 355

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1306865357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 200173",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753200173",
            "telephone_number": "405-252-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 HEALTH CENTER PKWY",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996381",
            "telephone_number": "405-717-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRIS CANADIAN VALLEY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2025-09-02",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ASSISTANT TREASURER",
        "authorized_official_telephone_number": "636-359-4890"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "OK",
            "license": "2343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100700610A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "INTEGRIS@DIRECT.INTEGRISOK.COM",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1201 Health Center Pkwy",
            "city": "Yukon",
            "state": "OK",
            "country_code": "US",
            "postal_code": "730996381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Integris Canadian Valley Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yukon, OK

Sources for this page

Verify at the official NPI Registry.