Provider Demographics
NPI:1295934339
Name:PRAGUE PUBLIC SCHOOL
Entity type:Organization
Organization Name:PRAGUE PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-567-4455
Mailing Address - Street 1:3504 NBU
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-2031
Mailing Address - Country:US
Mailing Address - Phone:405-567-4455
Mailing Address - Fax:405-567-3095
Practice Address - Street 1:3504 NBU
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-2031
Practice Address - Country:US
Practice Address - Phone:405-567-4455
Practice Address - Fax:405-567-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK255K00000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)