Provider Demographics
NPI:1740385657
Name:MARYETTA SCHOOL
Entity Type:Organization
Organization Name:MARYETTA SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARTHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-696-2285
Mailing Address - Street 1:RR 6 BOX 2840
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-9452
Mailing Address - Country:US
Mailing Address - Phone:918-696-2285
Mailing Address - Fax:918-696-6746
Practice Address - Street 1:RR 6 BOX 2840
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-9452
Practice Address - Country:US
Practice Address - Phone:918-696-2285
Practice Address - Fax:918-696-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health