Healthcare Provider Details

I. General information

NPI: 1346313814
Provider Name (Legal Business Name): BOARD OF EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HORNET DR
FULTON MO
65251-2732
US

IV. Provider business mailing address

2 HORNET DR
FULTON MO
65251-2732
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-2206
  • Fax: 573-642-1444
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: DR. MARK ENDERLE
Title or Position: SUPERINTENDENT
Credential:
Phone: 573-642-2206