Healthcare Provider Details

I. General information

NPI: 1912020546
Provider Name (Legal Business Name): CANEY PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N COBB AVE
CANEY OK
74533
US

IV. Provider business mailing address

PO BOX 60
CANEY OK
74533-0060
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-6608
  • Fax:
Mailing address:
  • Phone: 580-889-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. TOMMY R JOHNSON
Title or Position: SUPERINTENDENT
Credential:
Phone: 580-889-1996