Healthcare Provider Details

I. General information

NPI: 1265450449
Provider Name (Legal Business Name): OKANOGAN SCHOOL DISTRICT #105
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 SOUTH FIFTH ST
OKANOGAN WA
98840
US

IV. Provider business mailing address

1118 SOUTH FIFTH ST PO BOX 592
OKANOGAN WA
98840
US

V. Phone/Fax

Practice location:
  • Phone: 509-422-3580
  • Fax: 509-422-1639
Mailing address:
  • Phone: 509-422-3580
  • Fax: 509-422-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD JOHNSON
Title or Position: SUPERINTENDENT
Credential:
Phone: 509-422-3629