Healthcare Provider Details

I. General information

NPI: 1164404190
Provider Name (Legal Business Name): WESTVILLE PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W. CHINCAPIN
WESTVILLE OK
74965-0410
US

IV. Provider business mailing address

500 W. CHINCAPIN
WESTVILLE OK
74965-0410
US

V. Phone/Fax

Practice location:
  • Phone: 918-723-3181
  • Fax: 918-723-3042
Mailing address:
  • Phone: 918-723-3181
  • Fax: 918-723-3042

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: MRS. SHERRI PRENTICE
Title or Position: SUPERINTENDENT
Credential:
Phone: 918-723-3181