Provider Demographics
NPI:1437313236
Name:MCDONALD COUNTY R-1 SCHOOLS
Entity Type:Organization
Organization Name:MCDONALD COUNTY R-1 SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-845-3409
Mailing Address - Street 1:100 MUSTANG DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-7305
Mailing Address - Country:US
Mailing Address - Phone:417-845-3409
Mailing Address - Fax:417-845-7053
Practice Address - Street 1:100 MUSTANG DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-7305
Practice Address - Country:US
Practice Address - Phone:417-845-3409
Practice Address - Fax:417-845-7053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506163104Medicaid