Provider Demographics
NPI:1760563852
Name:CIMARRON PUBLIC SCHOOL
Entity Type:Organization
Organization Name:CIMARRON PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR/SLP
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:TYDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-796-2204
Mailing Address - Street 1:301 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:LAHOMA
Mailing Address - State:OK
Mailing Address - Zip Code:73754-0008
Mailing Address - Country:US
Mailing Address - Phone:580-796-2204
Mailing Address - Fax:580-796-2350
Practice Address - Street 1:301 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73754-0008
Practice Address - Country:US
Practice Address - Phone:580-796-2204
Practice Address - Fax:580-796-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare