Provider Demographics
NPI:1982002952
Name:BELLEVUE ELEMENTARY SCHOOL
Entity Type:Organization
Organization Name:BELLEVUE ELEMENTARY SCHOOL
Other - Org Name:OAK GROVE ELEMENTARY SCHOOL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SUPERINTENDENT OF EDUCATION
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:601-794-1030
Mailing Address - Street 1:424 MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-5028
Mailing Address - Country:US
Mailing Address - Phone:601-974-1030
Mailing Address - Fax:
Practice Address - Street 1:1760 OLD HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8235
Practice Address - Country:US
Practice Address - Phone:601-264-6724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR888519163WS0200X
MS876971261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07886262Medicaid