Provider Demographics
NPI:1578785820
Name:MOUND BAYOU PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:MOUND BAYOU PUBLIC SCHOOLS
Other - Org Name:I T MONTGOMERY ELEMENTARY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERIENTDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-741-2555
Mailing Address - Street 1:201 GREENE STREET
Mailing Address - Street 2:
Mailing Address - City:MOUND BAYOU
Mailing Address - State:MS
Mailing Address - Zip Code:38762
Mailing Address - Country:US
Mailing Address - Phone:662-741-2555
Mailing Address - Fax:662-741-2578
Practice Address - Street 1:202 MLK
Practice Address - Street 2:
Practice Address - City:MOUND BAYOU
Practice Address - State:MS
Practice Address - Zip Code:38762
Practice Address - Country:US
Practice Address - Phone:662-741-2433
Practice Address - Fax:662-741-2578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000098393163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00686243Medicaid