Provider Demographics
NPI:1902139884
Name:SIERRA VISTA PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:SIERRA VISTA PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:XENOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-515-2986
Mailing Address - Street 1:1313 S LENZNER AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4878
Mailing Address - Country:US
Mailing Address - Phone:520-515-2980
Mailing Address - Fax:520-515-2985
Practice Address - Street 1:1313 S. LENZNER
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-515-2980
Practice Address - Fax:520-515-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN111990261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ579633Medicaid