Provider Demographics
NPI:1316005499
Name:SUPT WEST SIDE SCHOOLS
Entity Type:Organization
Organization Name:SUPT WEST SIDE SCHOOLS
Other - Org Name:WEST SIDE SCHOOL DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-825-6258
Mailing Address - Street 1:7295 GREERS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:GREERS FERRY
Mailing Address - State:AR
Mailing Address - Zip Code:72067-9416
Mailing Address - Country:US
Mailing Address - Phone:501-825-6258
Mailing Address - Fax:501-825-6258
Practice Address - Street 1:7295 GREERS FERRY RD
Practice Address - Street 2:
Practice Address - City:GREERS FERRY
Practice Address - State:AR
Practice Address - Zip Code:72067-9416
Practice Address - Country:US
Practice Address - Phone:501-825-6258
Practice Address - Fax:501-825-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148664743Medicaid
AR148451742Medicaid