Provider Demographics
NPI:1073643805
Name:MOUNTAINBURG PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:MOUNTAINBURG PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-369-2121
Mailing Address - Street 1:129 HIGHWAY 71 SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72946-4112
Mailing Address - Country:US
Mailing Address - Phone:479-369-2121
Mailing Address - Fax:479-369-2138
Practice Address - Street 1:129 HIGHWAY 71 SW
Practice Address - Street 2:
Practice Address - City:MOUNTAINBURG
Practice Address - State:AR
Practice Address - Zip Code:72946-4112
Practice Address - Country:US
Practice Address - Phone:479-369-2121
Practice Address - Fax:479-369-2138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR127641743Medicaid
AR163766761Medicaid
AR130084721Medicaid
AR133622721Medicaid
AR143785721Medicaid
AR146317721Medicaid
AR139375742Medicaid
AR129332721Medicaid