Provider Demographics
NPI:1912177965
Name:MADISON PARISH SCHOOL BOARD
Entity Type:Organization
Organization Name:MADISON PARISH SCHOOL BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-3616
Mailing Address - Street 1:301 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-4205
Mailing Address - Country:US
Mailing Address - Phone:318-574-3616
Mailing Address - Fax:318-574-9290
Practice Address - Street 1:301 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4205
Practice Address - Country:US
Practice Address - Phone:318-574-3616
Practice Address - Fax:318-574-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1415278Medicaid