Provider Demographics
NPI:1962617530
Name:EAST TALLAHATCHIE SCHOOLS
Entity type:Organization
Organization Name:EAST TALLAHATCHIE SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-647-5524
Mailing Address - Street 1:411 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-1701
Mailing Address - Country:US
Mailing Address - Phone:662-647-5524
Mailing Address - Fax:662-647-3720
Practice Address - Street 1:35 OAK GROVE ROAD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921
Practice Address - Country:US
Practice Address - Phone:662-647-5490
Practice Address - Fax:662-647-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR855475163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01535361Medicaid