Provider Demographics
NPI:1093866865
Name:WICKES SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WICKES SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-385-7101
Mailing Address - Street 1:130 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:WICKES
Mailing Address - State:AR
Mailing Address - Zip Code:71973-9312
Mailing Address - Country:US
Mailing Address - Phone:870-385-7101
Mailing Address - Fax:870-385-2238
Practice Address - Street 1:130 SCHOOL DR
Practice Address - Street 2:
Practice Address - City:WICKES
Practice Address - State:AR
Practice Address - Zip Code:71973-9312
Practice Address - Country:US
Practice Address - Phone:870-385-7101
Practice Address - Fax:870-385-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1486000721Medicaid