Healthcare Provider Details

I. General information

NPI: 1669546289
Provider Name (Legal Business Name): LOWREY PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21132 E 640 RD
TAHLEQUAH OK
74464-8775
US

IV. Provider business mailing address

21132 E 640 RD
TAHLEQUAH OK
74464-8775
US

V. Phone/Fax

Practice location:
  • Phone: 918-456-4053
  • Fax: 918-458-0647
Mailing address:
  • Phone: 918-456-4053
  • Fax: 918-458-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. SCOT TROWER
Title or Position: SUPERINTENDENT
Credential:
Phone: 918-456-4053