Healthcare Provider Details

I. General information

NPI: 1104078245
Provider Name (Legal Business Name): COLE COUNTY R-I SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 PARK ST
RUSSELLVILLE MO
65074-1232
US

IV. Provider business mailing address

13111 PARK ST
RUSSELLVILLE MO
65074-1232
US

V. Phone/Fax

Practice location:
  • Phone: 573-782-3325
  • Fax:
Mailing address:
  • Phone: 573-782-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number251300000X
License Number StateMO

VIII. Authorized Official

Name: MS. LAURA E. RYAN
Title or Position: DIRECTOR OF SPECIAL SERVICES
Credential:
Phone: 573-782-3325