1013049865 NPI number — MIDWAY PUBLIC SCHOOL

Table of content: (NPI 1013049865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013049865 NPI number — MIDWAY PUBLIC SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWAY PUBLIC SCHOOL
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:
1013049865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3RD & PINE STREET
Provider Second Line Business Mailing Address:
P. O. BOX 170
Provider Business Mailing Address City Name:
COUNCIL HILL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3RD & PINE ST.
Provider Second Line Business Practice Location Address:
BOX 170
Provider Business Practice Location Address City Name:
COUNCIL HILL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-474-3434
Provider Business Practice Location Address Fax Number:
918-474-3636
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VOIGT
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
BILLING CLERK
Authorized Official Telephone Number:
918-474-3434

Provider Taxonomy Codes

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

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





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