Provider Demographics
NPI:1326112947
Name:SHADY GROVE PUBLIC SCHOOL
Entity Type:Organization
Organization Name:SHADY GROVE PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-772-2511
Mailing Address - Street 1:11042 W SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-4154
Mailing Address - Country:US
Mailing Address - Phone:918-772-2511
Mailing Address - Fax:918-772-2430
Practice Address - Street 1:11042 W SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:HULBERT
Practice Address - State:OK
Practice Address - Zip Code:74441-4154
Practice Address - Country:US
Practice Address - Phone:918-772-2511
Practice Address - Fax:918-772-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)