Healthcare Provider Details

I. General information

NPI: 1467859264
Provider Name (Legal Business Name): LAMAR COUNTY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BILBO RD
LUMBERTON MS
39455-8670
US

IV. Provider business mailing address

424 MARTIN LUTHER KING DR
PURVIS MS
39475-5028
US

V. Phone/Fax

Practice location:
  • Phone: 601-796-4483
  • Fax:
Mailing address:
  • Phone: 601-794-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR888519
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number876971
License Number StateMS

VIII. Authorized Official

Name: MRS. TESS SMITH
Title or Position: SUPERINTENDENT
Credential:
Phone: 601-794-1030