Healthcare Provider Details

I. General information

NPI: 1154313948
Provider Name (Legal Business Name): INDEPENDENT SCHOOL DISTRICT NUMBER 1 OF TULSA COUNTY, OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 S NEW HAVEN AVE
TULSA OK
74114-6131
US

IV. Provider business mailing address

3027 S NEW HAVEN AVE
TULSA OK
74114-6131
US

V. Phone/Fax

Practice location:
  • Phone: 918-746-6137
  • Fax: 918-746-6341
Mailing address:
  • Phone: 918-746-6137
  • Fax: 918-746-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DALE WENDELL SNOW
Title or Position: PROGRAM SUPERVISOR
Credential:
Phone: 918-746-6137