Provider Demographics
NPI:1003956475
Name:BISMARCK R-V SCHOOL DISTRICT
Entity type:Organization
Organization Name:BISMARCK R-V SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT/BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-734-6111
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:101 DENNIS DRIVE
Mailing Address - City:BISMARCK
Mailing Address - State:MO
Mailing Address - Zip Code:63624-0257
Mailing Address - Country:US
Mailing Address - Phone:573-734-6111
Mailing Address - Fax:573-734-2957
Practice Address - Street 1:101 DENNIS DRIVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:MO
Practice Address - Zip Code:63624-0257
Practice Address - Country:US
Practice Address - Phone:573-734-6111
Practice Address - Fax:573-734-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2016-06-13
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
MO506073808Medicaid