Healthcare Provider Details

I. General information

NPI: 1225135544
Provider Name (Legal Business Name): HEAVENER PUBLIC SCHOOL (LEA)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEST 2ND AND AVENUE C
HEAVENER OK
74937-0698
US

IV. Provider business mailing address

WEST 2ND AND AVENUE C P.O. BOX 698
HEAVENER OK
74937-0698
US

V. Phone/Fax

Practice location:
  • Phone: 918-653-4936
  • Fax:
Mailing address:
  • Phone: 918-653-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAY WILLIAMS
Title or Position: DIRECTOR
Credential:
Phone: 918-653-4936