Basic Information
| Provider Information | |||||||||
| NPI: | 1568662609 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAYETTE COUNTY BOARD OF EDUCATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 404 OLD MAIN DR | ||||||||
| Address2: | |||||||||
| City: | SUMMERSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 266511360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048726440 | ||||||||
| FaxNumber: | 3048726442 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 FAYETTE AVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258401219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045741176 | ||||||||
| FaxNumber: | 3045743643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2007 | ||||||||
| LastUpdateDate: | 07/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | RADER | ||||||||
| AuthorizedOfficialFirstName: | BILLIE | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAID SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3048726440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | WV | Y | Agencies | Local Education Agency (LEA) |
No ID Information.