Provider Demographics
NPI:1356593263
Name:STEPHENS SCHOOL DISTRICT
Entity type:Organization
Organization Name:STEPHENS SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-786-5443
Mailing Address - Street 1:315 WEST CHERT
Mailing Address - Street 2:
Mailing Address - City:STEPHENS
Mailing Address - State:AR
Mailing Address - Zip Code:71764
Mailing Address - Country:US
Mailing Address - Phone:870-786-5443
Mailing Address - Fax:870-786-5095
Practice Address - Street 1:315 WEST CHERT
Practice Address - Street 2:
Practice Address - City:STEPHENS
Practice Address - State:AR
Practice Address - Zip Code:71764
Practice Address - Country:US
Practice Address - Phone:870-786-5443
Practice Address - Fax:870-786-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR131091742251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131091742Medicaid