Provider Demographics
NPI:1568509958
Name:DAVIESS COUNTY BOARD OF EDUCATION
Entity Type:Organization
Organization Name:DAVIESS COUNTY BOARD OF EDUCATION
Other - Org Name:DAVIESS COUNTY PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-852-7000
Mailing Address - Street 1:PO BOX 21510
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-1510
Mailing Address - Country:US
Mailing Address - Phone:270-852-7000
Mailing Address - Fax:
Practice Address - Street 1:1622 SOUTHEASTERN PKWY
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1826
Practice Address - Country:US
Practice Address - Phone:270-852-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21030010251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21030010Medicaid