Healthcare Provider Details

I. General information

NPI: 1215031786
Provider Name (Legal Business Name): SMYTH COUNTY PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BAGLEY CIR SUITE 300
MARION VA
24354-3140
US

IV. Provider business mailing address

121 BAGLEY CIRCLE SUITE 300
MARION VA
24354
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-3791
  • Fax: 276-783-3291
Mailing address:
  • Phone: 276-783-3791
  • Fax: 276-783-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1215031786
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number251300000X
License Number StateVA

VIII. Authorized Official

Name: MR. STEVEN DOUGLAS BLEVINS
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential:
Phone: 276-783-3791