Provider Demographics
NPI:1831230374
Name:SPAVINAW SCHOOL
Entity type:Organization
Organization Name:SPAVINAW SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:MIDGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-589-2797
Mailing Address - Street 1:P.O. BOX 108
Mailing Address - Street 2:100 LAKE AVE
Mailing Address - City:SPAVINAW
Mailing Address - State:OK
Mailing Address - Zip Code:74366
Mailing Address - Country:US
Mailing Address - Phone:918-589-2228
Mailing Address - Fax:918-589-2476
Practice Address - Street 1:100 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SPAVINAW
Practice Address - State:OK
Practice Address - Zip Code:74366
Practice Address - Country:US
Practice Address - Phone:918-589-2228
Practice Address - Fax:918-589-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200000840A251K00000X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare