Provider Demographics
NPI:1164549291
Name:SUPERINTENDENT OF HAMBURG HIGH
Entity Type:Organization
Organization Name:SUPERINTENDENT OF HAMBURG HIGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-853-2864
Mailing Address - Street 1:521 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:AR
Mailing Address - Zip Code:71646-3303
Mailing Address - Country:US
Mailing Address - Phone:870-853-2864
Mailing Address - Fax:870-853-8264
Practice Address - Street 1:521 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-3303
Practice Address - Country:US
Practice Address - Phone:870-853-2864
Practice Address - Fax:870-853-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116484743Medicaid
AR126730742Medicaid
AR162194761Medicaid