Provider Demographics
NPI:1629351846
Name:THACKERVILLE PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:THACKERVILLE PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-276-2630
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:THACKERVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:73459-0377
Mailing Address - Country:US
Mailing Address - Phone:580-276-2630
Mailing Address - Fax:580-276-2638
Practice Address - Street 1:HWY 77 AND HWY 153
Practice Address - Street 2:
Practice Address - City:THACKERVILLE
Practice Address - State:OK
Practice Address - Zip Code:73459-0377
Practice Address - Country:US
Practice Address - Phone:580-276-2630
Practice Address - Fax:580-276-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)