Healthcare Provider Details

I. General information

NPI: 1861552408
Provider Name (Legal Business Name): PALMYRA R-I SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 SOUTH MAIN STREET
PALMYRA MO
63461
US

IV. Provider business mailing address

1723 SOUTH MAIN STREET
PALMYRA MO
63461
US

V. Phone/Fax

Practice location:
  • Phone: 573-769-2067
  • 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 StateMO

VIII. Authorized Official

Name: GEORGE GRIFFIN
Title or Position: COORDINATOR OF SPECIAL PROGRAMS
Credential:
Phone: 573-769-2067