Provider Demographics
NPI:1376663203
Name:NORTHERN OTTAWA COUNTY CO-OP
Entity Type:Organization
Organization Name:NORTHERN OTTAWA COUNTY CO-OP
Other - Org Name:PICHER-CARDIN PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:SPECIAL ED DIRECTOR-MEDICAID CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-673-1714
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:PICHER
Mailing Address - State:OK
Mailing Address - Zip Code:74360-0280
Mailing Address - Country:US
Mailing Address - Phone:918-673-1714
Mailing Address - Fax:918-673-1718
Practice Address - Street 1:715 WEST A STREET
Practice Address - Street 2:
Practice Address - City:PICHER
Practice Address - State:OK
Practice Address - Zip Code:74360
Practice Address - Country:US
Practice Address - Phone:918-673-1714
Practice Address - Fax:918-673-1718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare