Healthcare Provider Details

I. General information

NPI: 1487733630
Provider Name (Legal Business Name): MEXICO PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S JEFFERSON ST
MEXICO MO
65265-2563
US

IV. Provider business mailing address

2101 LAKEVIEW ROAD
MEXICO MO
65265
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-3773
  • Fax: 573-581-4410
Mailing address:
  • Phone: 573-581-3773
  • Fax: 573-581-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateMO

VIII. Authorized Official

Name: MR. KEVIN FREEMAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 573-581-3773