Provider Demographics
NPI:1639394059
Name:SUPERINTENDENT OF CUSHMAN SCHOOL DIST 81
Entity Type:Organization
Organization Name:SUPERINTENDENT OF CUSHMAN SCHOOL DIST 81
Other - Org Name:CUSHMAN SCHOOL DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-793-6321
Mailing Address - Street 1:45 PARK ST
Mailing Address - Street 2:
Mailing Address - City:CUSHMAN
Mailing Address - State:AR
Mailing Address - Zip Code:72526
Mailing Address - Country:US
Mailing Address - Phone:870-793-6321
Mailing Address - Fax:870-793-7266
Practice Address - Street 1:45 PARK ST
Practice Address - Street 2:
Practice Address - City:CUSHMAN
Practice Address - State:AR
Practice Address - Zip Code:72526
Practice Address - Country:US
Practice Address - Phone:870-793-6321
Practice Address - Fax:870-793-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148302742Medicaid