MEDICARE: LIBERTY PUBLIC SSCHOOL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency		OK

General Provider Information

NPI Number	:	1396733184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY PUBLIC SSCHOOL

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:
City	:	ROLAND
State	:	OK
Zip	:	74954-0070
Country	:	US
Telephone Number	:	918-427-3808
Fax Number	:	918-427-4961

Provider Business Practice Location Address
First Line	:	SWON ROAD
Second Line	:
City	:	ROLAND
State	:	OK
Zip	:	74954
Country	:	US
Telephone Number	:	918-427-3808
Fax Number	:	918-427-4961

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. JEFF RANSOM
Credential	:
Telephone Number	:	918-427-3808

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	08/22/2020

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Directions to “LIBERTY PUBLIC SSCHOOL ” Practice Location

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