Provider Demographics
NPI:1619152790
Name:WAYNE COUNTY SCHOOLS
Entity Type:Organization
Organization Name:WAYNE COUNTY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:P
Authorized Official - Last Name:STATEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-735-5151
Mailing Address - Street 1:810 CHICKASAWHAY ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2628
Mailing Address - Country:US
Mailing Address - Phone:601-735-5151
Mailing Address - Fax:601-735-7168
Practice Address - Street 1:810 CHICKASAWHAY ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2628
Practice Address - Country:US
Practice Address - Phone:601-735-5151
Practice Address - Fax:601-735-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSNA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04156291Medicaid