Provider Demographics
NPI:1922210236
Name:LAMAR COUNTY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:LAMAR COUNTY SCHOOL DISTRICT
Other - Org Name:PURVIS ELEMENTARY SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDANT OF EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-794-1030
Mailing Address - Street 1:300 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475
Mailing Address - Country:US
Mailing Address - Phone:601-794-1030
Mailing Address - Fax:
Practice Address - Street 1:310 MITCHELL AVE
Practice Address - Street 2:PURVIS UPPER ELEMENTARY SCHOOL
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475
Practice Address - Country:US
Practice Address - Phone:601-794-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863306163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09983571Medicaid