=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275865321
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFERSON COUNTY SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2010
-----------------------------------------------------
Last Update Date | 01/31/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 942 MAIN STREET
-----------------------------------------------------
City | FAYETTE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-786-3721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 942 MAIN STREET
-----------------------------------------------------
City | FAYETTE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT SUPERINTENDENT
-----------------------------------------------------
Name | MR. TRACY COOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-786-3721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------