Provider Demographics
NPI:1407809452
Name:COUNTY OF MAJOR FAIRVIEW SCHOOL DIST 84
Entity Type:Organization
Organization Name:COUNTY OF MAJOR FAIRVIEW SCHOOL DIST 84
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-227-2531
Mailing Address - Street 1:408 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-2110
Mailing Address - Country:US
Mailing Address - Phone:580-227-2531
Mailing Address - Fax:580-227-2642
Practice Address - Street 1:408 E BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-2110
Practice Address - Country:US
Practice Address - Phone:580-227-2531
Practice Address - Fax:580-227-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100687230AMedicaid