Provider Demographics
NPI:1306014592
Name:PETAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PETAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-545-3002
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-0523
Mailing Address - Country:US
Mailing Address - Phone:601-545-3002
Mailing Address - Fax:601-583-0150
Practice Address - Street 1:115 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465-2808
Practice Address - Country:US
Practice Address - Phone:601-545-3002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR510955163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01606558Medicaid