Provider Demographics
NPI:1417189119
Name:LAUDERDALE CO. SCHOOL DISTRICT
Entity Type:Organization
Organization Name:LAUDERDALE CO. SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-693-1683
Mailing Address - Street 1:702 BRIARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-9437
Mailing Address - Country:US
Mailing Address - Phone:601-679-8523
Mailing Address - Fax:601-679-7515
Practice Address - Street 1:702 BRIARWOOD RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-9437
Practice Address - Country:US
Practice Address - Phone:601-679-8523
Practice Address - Fax:601-679-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR529834163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04172558Medicaid