MEDICARE: PONCA CITY PUBLIC SCHOOL

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)	251K00000X	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770655839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PONCA CITY PUBLIC SCHOOL

Provider Business Mailing Address
First Line	:	111 W GRAND AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-5211
Country	:	US
Telephone Number	:	580-767-8000
Fax Number	:	580-767-8007

Provider Business Practice Location Address
First Line	:	111 W GRAND AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-5211
Country	:	US
Telephone Number	:	580-767-8000
Fax Number	:	580-767-8007

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL SERVICES
Name	:	MRS. PAT MORRIS
Credential	:
Telephone Number	:	580-767-8000

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	06/18/2008

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Directions to “PONCA CITY PUBLIC SCHOOL ” Practice Location

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