Healthcare Provider Details

I. General information

NPI: 1922210236
Provider Name (Legal Business Name): LAMAR COUNTY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MITCHELL AVE PURVIS UPPER ELEMENTARY SCHOOL
PURVIS MS
39475
US

IV. Provider business mailing address

300 NORTH STREET
PURVIS MS
39475
US

V. Phone/Fax

Practice location:
  • Phone: 601-794-2959
  • Fax:
Mailing address:
  • Phone: 601-794-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR863306
License Number StateMS

VIII. Authorized Official

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