Healthcare Provider Details

I. General information

NPI: 1851566640
Provider Name (Legal Business Name): LAMAR COUNTY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 TODD RD
SUMRALL MS
39482-5460
US

IV. Provider business mailing address

PO BOX 609
PURVIS MS
39475-0609
US

V. Phone/Fax

Practice location:
  • Phone: 601-758-4289
  • Fax: 601-758-4203
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 NumberR870939
License Number StateMS

VIII. Authorized Official

Name: DR. BEN BURNETT
Title or Position: SUPERINTENDENT
Credential:
Phone: 601-794-1030