Provider Demographics
NPI:1548484298
Name:SUPERINTENDENT OF DOVER PUBLIC SCHOOLS
Entity type:Organization
Organization Name:SUPERINTENDENT OF DOVER PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FEDERAL PROGRAMS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-331-2672
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:AR
Mailing Address - Zip Code:72837-0325
Mailing Address - Country:US
Mailing Address - Phone:479-331-2672
Mailing Address - Fax:479-331-3976
Practice Address - Street 1:109 COLLEGE ST.
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:AR
Practice Address - Zip Code:72837-0325
Practice Address - Country:US
Practice Address - Phone:479-331-2672
Practice Address - Fax:479-331-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118380761Medicaid
AR126752743Medicaid