Provider Demographics
NPI:1558580209
Name:JEFFERSON DAVIS PARISH SCHOOL BOARD
Entity Type:Organization
Organization Name:JEFFERSON DAVIS PARISH SCHOOL BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-824-1834
Mailing Address - Street 1:203 E PLAQUEMINE ST
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-5853
Mailing Address - Country:US
Mailing Address - Phone:337-824-1834
Mailing Address - Fax:
Practice Address - Street 1:203 E PLAQUEMINE ST
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-5853
Practice Address - Country:US
Practice Address - Phone:337-824-1834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1415286Medicaid
LA1701076Medicaid