Provider Demographics
NPI:1063769867
Name:STIDHAM SCHOOL
Entity type:Organization
Organization Name:STIDHAM SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:BANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-689-5241
Mailing Address - Street 1:HC 64 BOX 2110
Mailing Address - Street 2:
Mailing Address - City:EUSALA
Mailing Address - State:OK
Mailing Address - Zip Code:74432
Mailing Address - Country:US
Mailing Address - Phone:918-689-5241
Mailing Address - Fax:918-689-9163
Practice Address - Street 1:1ST AND MAIN
Practice Address - Street 2:
Practice Address - City:STIDHAM
Practice Address - State:OK
Practice Address - Zip Code:74461
Practice Address - Country:US
Practice Address - Phone:918-689-5241
Practice Address - Fax:918-689-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare