MEDICARE: VALIR OUTPATIENT CLINIC #5 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2255A2300X	Athletic Trainer
2	225700000X	Massage Therapist
3	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528593811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALIR OUTPATIENT CLINIC #5 LLC

Provider Business Mailing Address
First Line	:	700 NW 7TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1212
Country	:	US
Telephone Number	:	405-609-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	7005 SE 15TH ST
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-5100
Country	:	US
Telephone Number	:	405-610-2488
Fax Number	:	405-610-2484

Authorized Official
Title or Position	:	VP
Name	:	SAVANAH PATT
Credential	:
Telephone Number	:	405-609-3600

Provider Enumeration Date	:	04/25/2017
Last Update Date	:	03/22/2020

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