Provider Demographics
NPI:1447393475
Name:PILOT GROVE C-4
Entity Type:Organization
Organization Name:PILOT GROVE C-4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-834-4415
Mailing Address - Street 1:107 SCHOOL ST
Mailing Address - Street 2:ATTENTION JANNA LAMMERS
Mailing Address - City:PILOT GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65276-1026
Mailing Address - Country:US
Mailing Address - Phone:660-834-4415
Mailing Address - Fax:660-834-4401
Practice Address - Street 1:ATTENTION JANNA LAMMERS
Practice Address - Street 2:107 SCHOOL ST
Practice Address - City:PILOT GROVE
Practice Address - State:MO
Practice Address - Zip Code:65276-1026
Practice Address - Country:US
Practice Address - Phone:660-834-4415
Practice Address - Fax:660-834-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506079706Medicaid