1124156807 NPI number — COUNTY OF MAYES LOCUST GROVE SCHOOLS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124156807 NPI number — COUNTY OF MAYES LOCUST GROVE SCHOOLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MAYES LOCUST GROVE 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:
1124156807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 399
Provider Second Line Business Mailing Address:
419 NORTH BROADWAY
Provider Business Mailing Address City Name:
LOCUST GROVE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-479-5243
Provider Business Mailing Address Fax Number:
918-479-6468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 NORTH HIGHWAY 82
Provider Second Line Business Practice Location Address:
LOCUST GROVE MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
LOCUST GROVE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-479-5317
Provider Business Practice Location Address Fax Number:
918-479-5347
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
BILLIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
918-479-5243

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , 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)

  • Identifier: 100687900A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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