Provider Demographics
NPI:1336299536
Name:SUPERINTENDENT OF MARION SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SUPERINTENDENT OF MARION SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-739-5100
Mailing Address - Street 1:200 MANOR ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MANOR ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-1936
Practice Address - Country:US
Practice Address - Phone:870-739-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1003950304Medicaid
AR116926743Medicaid
AR118040742Medicaid
AR1730180837OtherPHYSICAN
AR1265432488OtherPHYSICAN
AR1003950304Medicaid
AR1013989029OtherPHYSICAN
AR116926743Medicaid
AR118040742Medicaid
AR1225039308OtherPHYSICAN
AR1821046608OtherPHYSICAN
AR1922009026OtherPHYSICAN