MEDICARE: FOREST GROVE SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1134472236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST GROVE SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 60
Second Line	:
City	:	GARVIN
State	:	OK
Zip	:	74736-0060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1941 FOREST GROVE ROAD
Second Line	:
City	:	GARVIN
State	:	OK
Zip	:	74736-0060
Country	:	US
Telephone Number	:	580-286-3961
Fax Number	:	580-286-3974

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	JOHN SMITH
Credential	:
Telephone Number	:	580-286-3961

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	10/26/2012

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Directions to “FOREST GROVE SCHOOL DISTRICT ” Practice Location

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