Provider Demographics
NPI:1568650885
Name:DEXTER SCHOOL
Entity Type:Organization
Organization Name:DEXTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYROLL, MEDICAID CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:LIESEL
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-614-1000
Mailing Address - Street 1:1031 BROWN PILOT LN
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-1803
Mailing Address - Country:US
Mailing Address - Phone:573-614-1000
Mailing Address - Fax:573-614-1002
Practice Address - Street 1:1031 BROWN PILOT LN
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-1803
Practice Address - Country:US
Practice Address - Phone:573-614-1000
Practice Address - Fax:573-614-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service