Provider Demographics
NPI:1821116765
Name:BUCKLIN PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:BUCKLIN PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-695-3555
Mailing Address - Street 1:26832 HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:BUCKLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64631-9230
Mailing Address - Country:US
Mailing Address - Phone:660-695-3555
Mailing Address - Fax:660-395-3345
Practice Address - Street 1:26832 HIGHWAY 129
Practice Address - Street 2:BUCKLIN PUBLIC SCHOOLS
Practice Address - City:BUCKLIN
Practice Address - State:MO
Practice Address - Zip Code:64631-9230
Practice Address - Country:US
Practice Address - Phone:660-695-3555
Practice Address - Fax:660-395-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506107903Medicaid