Provider Demographics
NPI:1437283579
Name:CONCORDIA PARISH SCHOOL BOARD
Entity Type:Organization
Organization Name:CONCORDIA PARISH SCHOOL BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:318-336-4226
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:4358 HIGHWAY 84W
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-0950
Mailing Address - Country:US
Mailing Address - Phone:318-336-4226
Mailing Address - Fax:318-336-5875
Practice Address - Street 1:508 JOHN DALE DR
Practice Address - Street 2:SUITE C
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-4097
Practice Address - Country:US
Practice Address - Phone:318-336-4732
Practice Address - Fax:318-336-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1415715Medicaid