Provider Demographics
NPI:1629195292
Name:SUPERINTENDENT OF PIGGOTT PUBLIC SCHOOL DISTRICT 52
Entity Type:Organization
Organization Name:SUPERINTENDENT OF PIGGOTT PUBLIC SCHOOL DISTRICT 52
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-598-2572
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-0387
Mailing Address - Country:US
Mailing Address - Phone:870-598-2572
Mailing Address - Fax:870-598-5283
Practice Address - Street 1:429 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-2822
Practice Address - Country:US
Practice Address - Phone:870-598-2572
Practice Address - Fax:870-598-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131361743Medicaid