Healthcare Provider Details

I. General information

NPI: 1821389289
Provider Name (Legal Business Name): LUMBERTON PUBLIC SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E 10TH AVE
LUMBERTON MS
39455-2513
US

IV. Provider business mailing address

107 E 10TH AVE
LUMBERTON MS
39455-2513
US

V. Phone/Fax

Practice location:
  • Phone: 601-796-2441
  • Fax:
Mailing address:
  • Phone: 601-796-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT WALKER
Title or Position: SUPERINTENDENT
Credential:
Phone: 601-796-2441