MEDICARE: DESOTO PARISH SCHOOL BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629241526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESOTO PARISH SCHOOL BOARD

Provider Business Mailing Address
First Line	:	210 CROSBY ST
Second Line	:
City	:	MANSFIELD
State	:	LA
Zip	:	71052-2614
Country	:	US
Telephone Number	:	318-872-3993
Fax Number	:	318-872-6501

Provider Business Practice Location Address
First Line	:	210 CROSBY ST
Second Line	:
City	:	MANSFIELD
State	:	LA
Zip	:	71052-2614
Country	:	US
Telephone Number	:	318-872-3993
Fax Number	:	318-872-6501

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. WALTER LEE
Credential	:
Telephone Number	:	318-872-3993

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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Directions to “DESOTO PARISH SCHOOL BOARD ” Practice Location

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