Healthcare Provider Details

I. General information

NPI: 1881736577
Provider Name (Legal Business Name): MEDFORD PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MAIN ST
MEDFORD OK
73759-1234
US

IV. Provider business mailing address

301 N MAIN ST
MEDFORD OK
73759-1234
US

V. Phone/Fax

Practice location:
  • Phone: 580-395-2392
  • Fax: 580-395-2391
Mailing address:
  • Phone: 580-395-2392
  • Fax: 580-395-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number2181
License Number StateOK

VIII. Authorized Official

Name: MR. JASON STERNBERGER
Title or Position: SUPERINTENDENT
Credential: M.A.
Phone: 580-395-2392