# LUCEDALE INTERMEDIATE SCHOOL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790116838
- **Authorized official:** MRS. JODI THERESA SUMRALL RN, ADN (SCHOOL NURSE)
- **Authorized official phone:** (601) 947-6993

## Contact information

- **Practice address:** 159 MABLE ST, LUCEDALE, MS 39452-5821
- **Practice address phone:** (601) 947-6065
- **Practice address fax:** (601) 947-6127
- **Mailing address:** 159 MABLE ST, LUCEDALE, MS 39452-5821
- **Mailing address phone:** (601) 947-6065
- **Mailing address fax:** (601) 947-6127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 390200000X | Student in an Organized Health Care Education/Training Program | R872149 | MS | Yes |

## Other

- **Enumeration date:** 11/27/2013
- **Last updated:** 11/27/2013