MEDICARE: SILOAM SPRINGS SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1386780948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILOAM SPRINGS SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	825 S MAPLE ST
Second Line	:	P.O. BOX798
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-4147
Country	:	US
Telephone Number	:	479-524-8130
Fax Number	:	479-549-3154

Provider Business Practice Location Address
First Line	:	825 S MAPLE ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-4147
Country	:	US
Telephone Number	:	479-524-8130
Fax Number	:	479-549-3154

Authorized Official
Title or Position	:	SPECIAL EDUCATION SUPERVISOR
Name	:	MRS. DORIS MARIE HENDERSON
Credential	:
Telephone Number	:	479-524-8130

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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