Provider Demographics
NPI:1902964471
Name:SUPERINTENDENT OF POTTSVILLE SCHOOLS
Entity Type:Organization
Organization Name:SUPERINTENDENT OF POTTSVILLE SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-968-8101
Mailing Address - Street 1:63 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72858-8717
Mailing Address - Country:US
Mailing Address - Phone:479-968-8101
Mailing Address - Fax:479-968-6339
Practice Address - Street 1:63 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72858-8717
Practice Address - Country:US
Practice Address - Phone:479-968-8101
Practice Address - Fax:479-968-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122048742Medicaid