Healthcare Provider Details

I. General information

NPI: 1760693675
Provider Name (Legal Business Name): WEBSTER COUNTY SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 3 BOX 81
MATHISTON MS
39752-9706
US

IV. Provider business mailing address

212 W CLARK AVE
EUPORA MS
39744-2704
US

V. Phone/Fax

Practice location:
  • Phone: 662-263-4402
  • Fax:
Mailing address:
  • Phone: 662-258-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR863259
License Number StateMS

VIII. Authorized Official

Name: JIMMY PITTMAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 662-258-5921