Provider Demographics
NPI:1699984914
Name:BETHEL PUBLIC SCHOOLS
Entity type:Organization
Organization Name:BETHEL PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-273-0385
Mailing Address - Street 1:36000 CLEAR POND ROAD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-2494
Mailing Address - Country:US
Mailing Address - Phone:405-273-0385
Mailing Address - Fax:405-273-5056
Practice Address - Street 1:36000 CLEAR POND ROAD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-2494
Practice Address - Country:US
Practice Address - Phone:405-273-0385
Practice Address - Fax:405-273-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
OK251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200042560AMedicaid