Healthcare Provider Details

I. General information

NPI: 1992902704
Provider Name (Legal Business Name): GOLDEN CITY R-III SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 WALNUT ST
GOLDEN CITY MO
64748-9104
US

IV. Provider business mailing address

406 E. 15TH
LOCKWOOD MO
65682
US

V. Phone/Fax

Practice location:
  • Phone: 417-537-4900
  • Fax: 417-537-8717
Mailing address:
  • Phone: 417-232-4914
  • Fax: 417-232-4568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number01860
License Number StateMO

VIII. Authorized Official

Name: MRS. SUSAN WHITTLE
Title or Position: SUPERINTENDENT
Credential:
Phone: 417-537-4900