Healthcare Provider Details

I. General information

NPI: 1740421221
Provider Name (Legal Business Name): BOARD OF EDUCATION MILBURN SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH 8TH STREET
MILBURN OK
73450
US

IV. Provider business mailing address

PO BOX 205
TISHOMINGO OK
73460-0205
US

V. Phone/Fax

Practice location:
  • Phone: 580-443-5522
  • Fax: 580-443-5303
Mailing address:
  • Phone: 580-443-5522
  • Fax: 580-443-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. JON HOLMES
Title or Position: SUPERINTENDANT
Credential:
Phone: 580-443-5522