Healthcare Provider Details

I. General information

NPI: 1922158658
Provider Name (Legal Business Name): GENOA CENTRAL SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12472 HIGHWAY 196
TEXARKANA AR
71854-1283
US

IV. Provider business mailing address

12472 HIGHWAY 196
TEXARKANA AR
71854-1283
US

V. Phone/Fax

Practice location:
  • Phone: 870-653-4343
  • Fax:
Mailing address:
  • Phone: 870-653-4343
  • Fax:

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. TED WALLER
Title or Position: SUPERINTENDENT
Credential:
Phone: 870-653-4343