Healthcare Provider Details

I. General information

NPI: 1356424865
Provider Name (Legal Business Name): KINGSTON PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE 3D STREET
KINGSTON OK
73439-0370
US

IV. Provider business mailing address

400 NE 3D STREET PO BOX 370
KINGSTON OK
73439-0370
US

V. Phone/Fax

Practice location:
  • Phone: 580-564-9033
  • Fax: 580-564-9516
Mailing address:
  • Phone: 580-564-9033
  • Fax: 580-564-9516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number251K00000X
License Number StateOK

VIII. Authorized Official

Name: MR. JAY MCADAMS
Title or Position: SUPERINTENDENT
Credential:
Phone: 580-564-9033