Healthcare Provider Details

I. General information

NPI: 1003940867
Provider Name (Legal Business Name): RUSSELLVILLE IND. SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 S SEMINARY ST
RUSSELLVILLE KY
42276
US

IV. Provider business mailing address

355 SEMINARY ST S
RUSSELLVILLE KY
42276
US

V. Phone/Fax

Practice location:
  • Phone: 270-726-8405
  • Fax: 270-726-4036
Mailing address:
  • Phone: 270-726-8405
  • Fax: 270-726-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ROGER COOK
Title or Position: SUPERINTENDENT
Credential:
Phone: 270-726-8405