Provider Demographics
NPI:1992806996
Name:SHADY POINT SCHOOLS
Entity type:Organization
Organization Name:SHADY POINT SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-963-2595
Mailing Address - Street 1:P.O. BOX 1005
Mailing Address - Street 2:
Mailing Address - City:SHADY POINT
Mailing Address - State:OK
Mailing Address - Zip Code:74956
Mailing Address - Country:US
Mailing Address - Phone:918-963-2595
Mailing Address - Fax:918-963-2605
Practice Address - Street 1:22838 WHEELUS STREET
Practice Address - Street 2:
Practice Address - City:SHADY POINT
Practice Address - State:OK
Practice Address - Zip Code:74956
Practice Address - Country:US
Practice Address - Phone:918-963-2595
Practice Address - Fax:918-963-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100681090AMedicaid