Healthcare Provider Details

I. General information

NPI: 1801917836
Provider Name (Legal Business Name): SUPERINTENDENT OF MT IDA PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 WHITTINGTON AVE
MOUNT IDA AR
71957-1230
US

IV. Provider business mailing address

PO BOX 1230
MOUNT IDA AR
71957-1230
US

V. Phone/Fax

Practice location:
  • Phone: 870-867-2661
  • Fax: 870-867-4552
Mailing address:
  • Phone: 870-867-2661
  • Fax: 870-867-4552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. BENNY WESTON
Title or Position: SUPERINTENDENT
Credential:
Phone: 870-867-2771