Provider Demographics
NPI:1366419871
Name:ANTLERS PUBLIC SCHOOLS
Entity type:Organization
Organization Name:ANTLERS PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-298-5504
Mailing Address - Street 1:219 NE A ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-3241
Mailing Address - Country:US
Mailing Address - Phone:580-298-5504
Mailing Address - Fax:508-298-4006
Practice Address - Street 1:219 NE A ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-3241
Practice Address - Country:US
Practice Address - Phone:580-298-5504
Practice Address - Fax:508-298-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251K00000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty