1245474147 NPI number — HOLIDAY ELEMENTARY SCHOOL

Table of content: (NPI 1245474147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245474147 NPI number — HOLIDAY ELEMENTARY SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLIDAY ELEMENTARY SCHOOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245474147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 647
Provider Second Line Business Mailing Address:
1700 CANTON ST.
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42241-0647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-887-4160
Provider Business Mailing Address Fax Number:
270-887-4165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3910 NASSAU CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-5344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-887-7210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STALLONS
Authorized Official First Name:
RITA
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCT. CLERK II
Authorized Official Telephone Number:
270-887-4160

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2110 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20024014 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15000029 . This is a "HANDS PROVIDER" identifier . This identifiers is of the category "OTHER".