Provider Demographics
NPI:1538281126
Name:VAN FAR R-I
Entity Type:Organization
Organization Name:VAN FAR R-I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:FORTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-594-6111
Mailing Address - Street 1:2200 W US HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:63382-1130
Mailing Address - Country:US
Mailing Address - Phone:573-594-6111
Mailing Address - Fax:573-594-2878
Practice Address - Street 1:2200 W US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:MO
Practice Address - Zip Code:63382-1130
Practice Address - Country:US
Practice Address - Phone:573-594-6111
Practice Address - Fax:573-594-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506196609Medicaid