Provider Demographics
NPI:1396898896
Name:SUPERINTENDENT OF MINERAL SPRINGS HIGH SCHOOL
Entity type:Organization
Organization Name:SUPERINTENDENT OF MINERAL SPRINGS HIGH SCHOOL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-287-4748
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MINERAL SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71851-0189
Mailing Address - Country:US
Mailing Address - Phone:870-287-4748
Mailing Address - Fax:870-287-5301
Practice Address - Street 1:130 WEST BROWNING ST
Practice Address - Street 2:
Practice Address - City:MINERAL SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71851-0189
Practice Address - Country:US
Practice Address - Phone:870-287-4748
Practice Address - Fax:870-287-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123186742Medicaid
AR123187743Medicaid
AR167859761Medicaid