=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245474147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLIDAY ELEMENTARY SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2009
-----------------------------------------------------
Last Update Date | 04/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3910 NASSAU CIR
-----------------------------------------------------
City | HOPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42240-5344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-887-7210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 647 1700 CANTON ST.
-----------------------------------------------------
City | HOPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42241-0647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-887-4160
-----------------------------------------------------
Fax | 270-887-4165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCT. CLERK II
-----------------------------------------------------
Name | RITA STALLONS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-887-4160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------