Provider Demographics
NPI:1558505396
Name:NORTH DRIVE MIDDLE SCHOOL
Entity Type:Organization
Organization Name:NORTH DRIVE MIDDLE SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT. CLERK II
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-887-4160
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:1700 CANTON ST.
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0647
Mailing Address - Country:US
Mailing Address - Phone:270-887-4160
Mailing Address - Fax:270-887-4165
Practice Address - Street 1:831 NORTH DR
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2649
Practice Address - Country:US
Practice Address - Phone:270-887-7150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
15000029OtherHANDS PROVIDER
KY20024014Medicaid
2110OtherMEDICARE PTAN
0211005Medicare PIN
C72225Medicare UPIN