1730586538 NPI number — LAMAR COUNTY SCHOOL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730586538 NPI number — LAMAR COUNTY SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAMAR COUNTY SCHOOL DISTRICT
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:
1730586538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 MARTIN LUTHER KING DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PURVIS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39475-5028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-794-1030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5976 US HIGHWAY 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PURVIS
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39475-5066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-794-3302
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
TESS
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
601-794-1030

Provider Taxonomy Codes

  • Taxonomy code: 163WS0200X , with the licence number:  R888519 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QS1000X , with the licence number: 876971 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NUMBER APPLIED FOR , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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