Provider Demographics
NPI:1871873729
Name:STARKVILLE OKTIBBEHA CONSOLIDATED SCHOOL DISTRICT
Entity type:Organization
Organization Name:STARKVILLE OKTIBBEHA CONSOLIDATED SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDANT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-324-4050
Mailing Address - Street 1:401 GREENSBORO STREET
Mailing Address - Street 2:STARKVILLE OKTIBBEHA CONSOLIDATED SCHOOL DISTRICT
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-324-4050
Mailing Address - Fax:662-324-4068
Practice Address - Street 1:603 YELLOWJACKET DRIVE
Practice Address - Street 2:STARKVILLE HIGH SCHOOL
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-324-4130
Practice Address - Fax:662-324-4128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STARKVILLE OKTIBBEHA CONSOLIDATED SCHOOLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-24
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR557102163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09600208Medicaid