Provider Demographics
NPI:1861110728
Name:MOUNDS PUBLIC SCHOOL
Entity type:Organization
Organization Name:MOUNDS PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN OFFICE/ENCUMBRANCE
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:LADAWN
Authorized Official - Last Name:BAZILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-827-6100
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-0189
Mailing Address - Country:US
Mailing Address - Phone:918-827-6100
Mailing Address - Fax:
Practice Address - Street 1:1603 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047-5446
Practice Address - Country:US
Practice Address - Phone:918-827-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)