Provider Demographics
NPI:1831324706
Name:B. F. LIDDELL MIDDLE SCHOOL
Entity Type:Organization
Organization Name:B. F. LIDDELL MIDDLE SCHOOL
Other - Org Name:NOXUBEE COUNTY SCHOOL DISTRICT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:WILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:662-726-2045
Mailing Address - Street 1:200 N WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MS
Mailing Address - Zip Code:39341-2530
Mailing Address - Country:US
Mailing Address - Phone:662-726-2045
Mailing Address - Fax:
Practice Address - Street 1:200 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MS
Practice Address - Zip Code:39341-2530
Practice Address - Country:US
Practice Address - Phone:662-726-2045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR727989390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08736809Medicaid