Provider Demographics
NPI:1952517252
Name:EAST AMORY ELEMENTARY SCHOOL
Entity Type:Organization
Organization Name:EAST AMORY ELEMENTARY SCHOOL
Other - Org Name:AMORY SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-256-9327
Mailing Address - Street 1:305 EASTHAVEN DR N
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-2103
Mailing Address - Country:US
Mailing Address - Phone:662-256-7191
Mailing Address - Fax:662-256-1647
Practice Address - Street 1:305 EASTHAVEN DR N
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-2103
Practice Address - Country:US
Practice Address - Phone:662-256-7191
Practice Address - Fax:662-256-1647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07254210Medicaid