Provider Demographics
NPI:1659401339
Name:SCHOOL OF THE OSAGE R-II
Entity Type:Organization
Organization Name:SCHOOL OF THE OSAGE R-II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-365-4091
Mailing Address - Street 1:P.O. BOX 1960, 1501 SCHOOL ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049
Mailing Address - Country:US
Mailing Address - Phone:573-365-7111
Mailing Address - Fax:573-365-5748
Practice Address - Street 1:636 HWY. 42, BOX 198
Practice Address - Street 2:
Practice Address - City:KAISER,
Practice Address - State:MO
Practice Address - Zip Code:65047
Practice Address - Country:US
Practice Address - Phone:573-365-7111
Practice Address - Fax:573-365-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0356421251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO463777300Medicaid