Healthcare Provider Details

I. General information

NPI: 1760511620
Provider Name (Legal Business Name): LAMAR COUNTY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5531 HWY 13 BAXTERVILLE SCHOOL
LUMBERTON MS
39455
US

IV. Provider business mailing address

PO BOX 609
PURVIS MS
39475
US

V. Phone/Fax

Practice location:
  • Phone: 601-796-4483
  • Fax: 601-796-5933
Mailing address:
  • Phone: 601-794-1030
  • Fax: 601-794-1012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR729744
License Number StateMS

VIII. Authorized Official

Name: MR. GLENN A SWAN
Title or Position: SUPERINTENDENT OF EDUCATION LAMAR C
Credential:
Phone: 601-794-1030