Provider Demographics
NPI:1639258080
Name:SCHOOL DISTRICT R-3 KEYTESVILLE
Entity Type:Organization
Organization Name:SCHOOL DISTRICT R-3 KEYTESVILLE
Other - Org Name:KEYTESVILLE R-III SCHOOL DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-288-3767
Mailing Address - Street 1:27247 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:KEYTESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65261-2401
Mailing Address - Country:US
Mailing Address - Phone:660-288-3767
Mailing Address - Fax:660-288-3110
Practice Address - Street 1:27247 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:KEYTESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65261-2401
Practice Address - Country:US
Practice Address - Phone:660-288-3767
Practice Address - Fax:660-288-3110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO506163609251300000X
251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506163609Medicaid