1669626594 NPI number — REORGANIZED SCHOOL DISTRICT 5

Table of content: (NPI 1669626594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669626594 NPI number — REORGANIZED SCHOOL DISTRICT 5

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
REORGANIZED SCHOOL DISTRICT 5
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:
DELTA R-V
Provider Other Organization Name Type Code:
3
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:
1669626594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELTA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63744-0219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-794-2500
Provider Business Mailing Address Fax Number:
573-794-2504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 E MCKINLEY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELTA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-794-2500
Provider Business Practice Location Address Fax Number:
573-794-2504
Provider Enumeration Date:
11/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIVINGSTON
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
SPECIAL SERVICES DIRECTOR
Authorized Official Telephone Number:
573-794-2500

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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