=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902020100
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMERON PUBLIC SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26661 W 5TH ST
-----------------------------------------------------
City | CAMERON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74932-2458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-654-3412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 14
-----------------------------------------------------
City | CAMERON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74932-0014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 918-654-7387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | MR. JOHN LONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-654-3225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------