Healthcare Provider Details

I. General information

NPI: 1497892582
Provider Name (Legal Business Name): VAN BUREN R-1 SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 BROADWAY
VAN BUREN MO
63965-0550
US

IV. Provider business mailing address

PO BOX 550
VAN BUREN MO
63965-0550
US

V. Phone/Fax

Practice location:
  • Phone: 573-323-4266
  • Fax: 573-323-4297
Mailing address:
  • Phone: 573-323-4281
  • Fax: 573-323-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number118330
License Number StateMO

VIII. Authorized Official

Name: DR. JEFFERY D LINDSEY
Title or Position: SUPERINTENDANT
Credential: E.D.D.
Phone: 573-323-4281