Provider Demographics
NPI:1801917836
Name:SUPERINTENDENT OF MT IDA PUBLIC SCHOOLS
Entity type:Organization
Organization Name:SUPERINTENDENT OF MT IDA PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-867-2771
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:MOUNT IDA
Mailing Address - State:AR
Mailing Address - Zip Code:71957-1230
Mailing Address - Country:US
Mailing Address - Phone:870-867-2661
Mailing Address - Fax:870-867-4552
Practice Address - Street 1:338 WHITTINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT IDA
Practice Address - State:AR
Practice Address - Zip Code:71957-1230
Practice Address - Country:US
Practice Address - Phone:870-867-2661
Practice Address - Fax:870-867-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171407761Medicaid