Provider Demographics
NPI:1952470981
Name:KETCHUM PUBLIC SCHOOL
Entity Type:Organization
Organization Name:KETCHUM PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:HISELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-782-5091
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:OK
Mailing Address - Zip Code:74349-0720
Mailing Address - Country:US
Mailing Address - Phone:918-782-5091
Mailing Address - Fax:918-782-9018
Practice Address - Street 1:404 NORTH BOSTON
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:OK
Practice Address - Zip Code:74349-0720
Practice Address - Country:US
Practice Address - Phone:918-782-5091
Practice Address - Fax:918-782-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)