Healthcare Provider Details

I. General information

NPI: 1235647629
Provider Name (Legal Business Name): REORGANIZED SCHOOL DIST 4
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HCR 7 BOX 51
DONIPHAN MO
63935
US

IV. Provider business mailing address

HCR 7 BOX 51
DONIPHAN MO
63935
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-7118
  • Fax: 573-996-7484
Mailing address:
  • Phone: 573-996-7118
  • Fax: 573-996-7484

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: CARLY CARTER
Title or Position: SPECIAL EDUCATION DIRECTOR
Credential:
Phone: 573-996-7118