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General NPI Number Information
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NPI Number | 1013191337
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Entity Type | Organization
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Legal Business Name | MOUND BAYOU PUBLIC SCHOOL DISTRICT
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 202 W MARTIN LUTHER KING ST
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City | MOUND BAYOU
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State | MS
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Zip | 38762-9775
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Country | US
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Telephone | 662-741-2433
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Fax |
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Provider Business Mailing Address
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Address Line | 301 MARTIN LUTHER KING ST
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City | MOUND BAYOU
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State | MS
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Zip | 38762-9738
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Country | US
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Telephone | 662-741-2555
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Fax | 662-741-2726
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | WILLIAM CROCKETT
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Credential | EDS ADMINISTRATION
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Telephone | 662-741-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 09015483
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License Number State | MS
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