Provider Demographics
NPI:1568904704
Name:HENDERSON WARD STEWART ELEMENTARY
Entity Type:Organization
Organization Name:HENDERSON WARD STEWART ELEMENTARY
Other - Org Name:STARKVILLE OKTIBBEHA CONSOLIDATED SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYESTHER
Authorized Official - Middle Name:MURPHY
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:662-418-2062
Mailing Address - Street 1:200 A. MARTIN LUTHER KING JR. DR.
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-418-2062
Mailing Address - Fax:
Practice Address - Street 1:200A MARTIN LUTHER KING JR DR W
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2890
Practice Address - Country:US
Practice Address - Phone:662-324-4160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STARKVILLE OKTIBBEHA CONSOLIDATED SCHOOL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04600378Medicaid