Organization
SOUTH CHRISTIAN ELEMENTARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RITA STALLONS (ACCT. CLERK II)
(270) 887-4160
Entity
Organization
Contact information
Practice address
12340 HERNDON OAK GROVE RD, HERNDON, KY 42236-8186
(270) 887-7350
Mailing address
PO BOX 647, 1700 CANTON ST., HOPKINSVILLE, KY 42241-0647
(270) 887-4160
(270) 887-4165
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15000029
HANDS PROVIDER
—
05
—
20024014
—
KY
01
—
2110
MEDICARE PTAN
—
Enumeration date
04/23/2009
Last updated
04/23/2009
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