Provider Demographics
NPI:1538472329
Name:AMBER-POCASSET
Entity Type:Organization
Organization Name:AMBER-POCASSET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:HANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-224-5768
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:AMBER
Mailing Address - State:OK
Mailing Address - Zip Code:73004-0038
Mailing Address - Country:US
Mailing Address - Phone:405-224-5768
Mailing Address - Fax:
Practice Address - Street 1:401 EAST MAIN
Practice Address - Street 2:
Practice Address - City:AMBER
Practice Address - State:OK
Practice Address - Zip Code:73004-0038
Practice Address - Country:US
Practice Address - Phone:405-224-5768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100688180AMedicaid