Jefferson C-123 School

Organization Active NPI Local Education Agency (LEA) · Conception Junction, MO

NPI 1063565901 · NPPES record last updated May 8, 2008

Key facts

NPI
1063565901
Entity type
Organization (NPI type 2)
Primary specialty
Local Education Agency (LEA) 251300000X
License
506127802 (MO)
Legal business name
JEFFERSON C-123 SCHOOL
Practice address
37614 US Highway 136
Conception Junction, MO 64434-8109
Phone
(660) 944-2316
Fax
(660) 944-2315
NPI assigned
Jan 22, 2007
Organization subpart
No

Authorized official

Name
Mr. Robert P. Dowis
Title
Superintendent
Phone
(660) 944-2316

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Local Education Agency (LEA) 251300000X 506127802 MO Yes

Addresses

Primary practice location

37614 US Highway 136
Conception Junction, MO 64434-8109

Mailing address

37614 US Highway 136
Conception Junction, MO 64434-8109
Phone (660) 944-2316

Other identifiers

IdentifierTypeStateIssuer
506127802MedicaidMO

Sources for this page

Verify at the official NPI Registry.