Basic Information
| Provider Information | |||||||||
| NPI: | 1801170311 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BOLTON EDWARDS ELEMENTARY MIDDLE SCHOOL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9700 I 20 | ||||||||
| Address2: | |||||||||
| City: | BOLTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390419126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018662522 | ||||||||
| FaxNumber: | 6018662524 | ||||||||
| Practice Location | |||||||||
| Address1: | 9700 I 20 | ||||||||
| Address2: | |||||||||
| City: | BOLTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390419126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018662522 | ||||||||
| FaxNumber: | 6018662524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 10/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | HANDLEY | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPERINTENDENT | ||||||||
| AuthorizedOfficialTelephone: | 6018575222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HINDS COUNTY SCHOOL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R867636 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse |
No ID Information.