Healthcare Provider Details

I. General information

NPI: 1093858714
Provider Name (Legal Business Name): PORTAGEVILLE SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 KING AVE
PORTAGEVILLE MO
63873-1378
US

IV. Provider business mailing address

904 KING AVE
PORTAGEVILLE MO
63873-1378
US

V. Phone/Fax

Practice location:
  • Phone: 573-379-3855
  • Fax: 573-379-5817
Mailing address:
  • Phone: 573-379-3855
  • Fax: 573-379-5817

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: MS. CHARLOTTE MARIE COLEMAN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 573-379-3855