Provider Demographics
NPI:1750723458
Name:HEAVENER PUBLIC SCHOOLS
Entity type:Organization
Organization Name:HEAVENER PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-653-7223
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:500 WEST 2ND STREET
Mailing Address - City:HEAVENER
Mailing Address - State:OK
Mailing Address - Zip Code:74937-0698
Mailing Address - Country:US
Mailing Address - Phone:918-653-7223
Mailing Address - Fax:918-653-7843
Practice Address - Street 1:500 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HEAVENER
Practice Address - State:OK
Practice Address - Zip Code:74937-3002
Practice Address - Country:US
Practice Address - Phone:918-653-7223
Practice Address - Fax:918-653-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100680070BMedicaid