Healthcare Provider Details

I. General information

NPI: 1346380326
Provider Name (Legal Business Name): FORDLAND R-3 SCHOOL DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 SCHOOL ST
FORDLAND MO
65652-9208
US

IV. Provider business mailing address

1230 SCHOOL ST
FORDLAND MO
65652-9208
US

V. Phone/Fax

Practice location:
  • Phone: 417-767-2298
  • Fax: 417-767-4483
Mailing address:
  • Phone: 417-767-2298
  • Fax: 417-767-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PORTER
Title or Position: ACCOUNTS PAYABLE
Credential:
Phone: 41776722998