Provider Demographics
NPI:1417102104
Name:GREASY PUBLIC SCHOOL
Entity Type:Organization
Organization Name:GREASY PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:EADS
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER DEGREE ADMIN
Authorized Official - Phone:918-696-7768
Mailing Address - Street 1:RR 1 BOX 1589
Mailing Address - Street 2:
Mailing Address - City:BUNCH
Mailing Address - State:OK
Mailing Address - Zip Code:74931-9740
Mailing Address - Country:US
Mailing Address - Phone:918-696-7768
Mailing Address - Fax:918-696-7240
Practice Address - Street 1:RR 1 BOX 1589
Practice Address - Street 2:
Practice Address - City:BUNCH
Practice Address - State:OK
Practice Address - Zip Code:74931-9740
Practice Address - Country:US
Practice Address - Phone:918-696-7768
Practice Address - Fax:918-696-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100684490AMedicaid