MEDICARE: ROLAND PUBLIC SCHOOLS

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	251K00000X	Public Health or Welfare Agency	251K00000X	OK

General Provider Information

NPI Number	:	1639131006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROLAND PUBLIC SCHOOLS

Provider Business Mailing Address
First Line	:	RR 1 BOX 1
Second Line	:
City	:	ROLAND
State	:	OK
Zip	:	74954-4003
Country	:	US
Telephone Number	:	918-427-4601
Fax Number	:	918-427-1785

Provider Business Practice Location Address
First Line	:	RR 1 BOX 1
Second Line	:
City	:	ROLAND
State	:	OK
Zip	:	74954-4003
Country	:	US
Telephone Number	:	918-427-4601
Fax Number	:	918-427-1785

Authorized Official
Title or Position	:	ASSISTANT SUPERINTENDENT
Name	:	MR. LARRY HENSON
Credential	:
Telephone Number	:	918-427-4601

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/22/2020

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Directions to “ROLAND PUBLIC SCHOOLS ” Practice Location

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