Provider Demographics
NPI:1497968044
Name:SUPERINTENDENT OF DE QUEEN HIGH SCHOOL
Entity Type:Organization
Organization Name:SUPERINTENDENT OF DE QUEEN HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:BOB
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-584-4312
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-0950
Mailing Address - Country:US
Mailing Address - Phone:870-584-4312
Mailing Address - Fax:870-642-8881
Practice Address - Street 1:101 N 9TH ST
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832
Practice Address - Country:US
Practice Address - Phone:870-584-4312
Practice Address - Fax:870-642-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124780742Medicaid