Basic Information
| Provider Information | |||||||||
| NPI: | 1982077178 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAIR GROVE R-X | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FAIR GROVE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656488436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177592233 | ||||||||
| FaxNumber: | 4177597150 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FAIR GROVE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656488436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4177592233 | ||||||||
| FaxNumber: | 4177597150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2015 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | REEVES | ||||||||
| AuthorizedOfficialFirstName: | JANET | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4177592233 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
No ID Information.