Healthcare Provider Details

I. General information

NPI: 1689079204
Provider Name (Legal Business Name): RED OAK SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N MAIN ST
RED OAK OK
74563
US

IV. Provider business mailing address

PO BOX 310
RED OAK OK
74563-0310
US

V. Phone/Fax

Practice location:
  • Phone: 918-754-2426
  • Fax: 918-754-2898
Mailing address:
  • Phone: 918-754-2426
  • Fax: 918-754-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number100681310
License Number StateOK

VIII. Authorized Official

Name: RANDY BRIGANCE
Title or Position: PRINCIPAL
Credential:
Phone: 918-754-2426