Provider Demographics
NPI:1528248416
Name:HEBER-OVERGAARD USD #6
Entity type:Organization
Organization Name:HEBER-OVERGAARD USD #6
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-535-4622
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:HEBER
Mailing Address - State:AZ
Mailing Address - Zip Code:85928-0547
Mailing Address - Country:US
Mailing Address - Phone:928-535-5146
Mailing Address - Fax:
Practice Address - Street 1:3375 BUCKSKIN CANYON RD.
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:AZ
Practice Address - Zip Code:85928
Practice Address - Country:US
Practice Address - Phone:928-535-5146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ640129Medicare PIN