Provider Demographics
NPI:1669718409
Name:MANNFORD PUBLIC SCHOOLS
Entity type:Organization
Organization Name:MANNFORD PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANNFORD PUBLIC SCHOOL
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDVOGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-865-2792
Mailing Address - Street 1:136 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-3152
Mailing Address - Country:US
Mailing Address - Phone:918-865-2792
Mailing Address - Fax:918-865-2813
Practice Address - Street 1:136 EVANS AVE
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044-3152
Practice Address - Country:US
Practice Address - Phone:918-865-2792
Practice Address - Fax:918-865-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicaid