Provider Demographics
NPI:1558562009
Name:MCCOMB SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MCCOMB SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINDINDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-684-4661
Mailing Address - Street 1:695 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4044
Mailing Address - Country:US
Mailing Address - Phone:601-684-4661
Mailing Address - Fax:
Practice Address - Street 1:695 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4044
Practice Address - Country:US
Practice Address - Phone:601-684-4661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS1081251300000X
MSS2523251300000X
MSS2405251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014865Medicaid