1245664580 NPI number — BLACKWELL PUBLIC SCHOOLS

Table of content: THADDEUS JOHN GOLEBIEWSKI III RPH (NPI 1134635055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245664580 NPI number — BLACKWELL PUBLIC SCHOOLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACKWELL PUBLIC SCHOOLS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245664580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E BLACKWELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLACKWELL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74631-2909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-363-2570
Provider Business Mailing Address Fax Number:
580-363-5513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E BLACKWELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACKWELL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74631-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-363-2570
Provider Business Practice Location Address Fax Number:
580-363-5513
Provider Enumeration Date:
08/22/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SILL
Authorized Official First Name:
MONTE
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
580-363-2570

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)