Healthcare Provider Details

I. General information

NPI: 1184709099
Provider Name (Legal Business Name): RAVIA PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N MILL ST
RAVIA OK
73455-0299
US

IV. Provider business mailing address

PO BOX 299 305 N. MILL ST.
RAVIA OK
73455-0299
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-9163
  • Fax: 580-371-3067
Mailing address:
  • Phone: 580-371-9163
  • Fax: 580-371-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number261QS1000X
License Number StateOK

VIII. Authorized Official

Name: KEVIN LEE DUNCAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 580-371-9163