Healthcare Provider Details

I. General information

NPI: 1780167650
Provider Name (Legal Business Name): EMINENCE R-1 SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17829 SOUTH 6TH STREET
EMINENCE MO
65466
US

IV. Provider business mailing address

PO BOX 730
EMINENCE MO
65466-0730
US

V. Phone/Fax

Practice location:
  • Phone: 573-226-3251
  • Fax:
Mailing address:
  • Phone:
  • 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: AMY ROLEN
Title or Position: BOOKKEEPER
Credential:
Phone: 573-226-3251