Provider Demographics
NPI:1164680997
Name:COLE CAMP R-I SCHOOL DISTRICT
Entity Type:Organization
Organization Name:COLE CAMP R-I SCHOOL DISTRICT
Other - Org Name:REORGANIZED SCHOOL DISTRICT R-I OF BENTON COUNTY
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-668-4427
Mailing Address - Street 1:500 S KEENEY ST
Mailing Address - Street 2:
Mailing Address - City:COLE CAMP
Mailing Address - State:MO
Mailing Address - Zip Code:65325-1059
Mailing Address - Country:US
Mailing Address - Phone:660-668-3011
Mailing Address - Fax:660-668-4703
Practice Address - Street 1:500 S KEENEY ST
Practice Address - Street 2:
Practice Address - City:COLE CAMP
Practice Address - State:MO
Practice Address - Zip Code:65325-1059
Practice Address - Country:US
Practice Address - Phone:660-668-3011
Practice Address - Fax:660-668-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506186303Medicaid