MEDICARE: WOODLAND R-IV SCHOOL DISTRICT

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)

General Provider Information

NPI Number	:	1699845040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND R-IV SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	ROUTE 5 BOX 3210
Second Line	:
City	:	MARBLE HILL
State	:	MO
Zip	:	63764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	ROUTE 5 BOX 3210
Second Line	:
City	:	MARBLE HILL
State	:	MO
Zip	:	63764
Country	:	US
Telephone Number	:	573-238-3343
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DENNIS PARHAM
Credential	:
Telephone Number	:	573-238-3343

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/22/2020

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Directions to “WOODLAND R-IV SCHOOL DISTRICT ” Practice Location

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