Provider Demographics
NPI:1003940867
Name:RUSSELLVILLE IND. SCHOOLS
Entity Type:Organization
Organization Name:RUSSELLVILLE IND. SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-726-8405
Mailing Address - Street 1:355 SEMINARY ST S
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276
Mailing Address - Country:US
Mailing Address - Phone:270-726-8405
Mailing Address - Fax:270-726-4036
Practice Address - Street 1:355 S SEMINARY ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276
Practice Address - Country:US
Practice Address - Phone:270-726-8405
Practice Address - Fax:270-726-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21071014Medicaid