Provider Demographics
NPI:1114904711
Name:MOYERS PUBLIC SCHOOL IO 22
Entity Type:Organization
Organization Name:MOYERS PUBLIC SCHOOL IO 22
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-298-5547
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:MOYERS
Mailing Address - State:OK
Mailing Address - Zip Code:74557
Mailing Address - Country:US
Mailing Address - Phone:580-298-5547
Mailing Address - Fax:580-298-2022
Practice Address - Street 1:H W 2 N COBB DRIVE
Practice Address - Street 2:
Practice Address - City:MOYERS
Practice Address - State:OK
Practice Address - Zip Code:74557
Practice Address - Country:US
Practice Address - Phone:580-298-5547
Practice Address - Fax:580-298-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100684050AMedicaid