Provider Demographics
NPI:1457455156
Name:CONWAY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CONWAY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:360-445-5785
Mailing Address - Street 1:19710 STATE ROUTE 534
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8026
Mailing Address - Country:US
Mailing Address - Phone:360-445-5785
Mailing Address - Fax:360-445-4511
Practice Address - Street 1:19710 STATE ROUTE 534
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-8026
Practice Address - Country:US
Practice Address - Phone:360-445-5785
Practice Address - Fax:360-445-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442726Medicaid