Provider Demographics
NPI:1083786586
Name:SCHOOL OF THE OSAGE R-II
Entity Type:Organization
Organization Name:SCHOOL OF THE OSAGE R-II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-365-4091
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-1960
Mailing Address - Country:US
Mailing Address - Phone:573-365-4091
Mailing Address - Fax:573-365-5748
Practice Address - Street 1:1501 SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-1960
Practice Address - Country:US
Practice Address - Phone:573-365-4091
Practice Address - Fax:573-365-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO503777302390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO483777306Medicaid
MO463777300Medicaid
MO473777308Medicaid