MEDICARE: LOGAN COUNTY SCHOOL DISTRICT RE-1

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033257274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGAN COUNTY SCHOOL DISTRICT RE-1

Provider Business Mailing Address
First Line	:	415 BEATTIE ST
Second Line	:
City	:	STERLING
State	:	CO
Zip	:	80751-3915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 BEATTIE ST
Second Line	:
City	:	STERLING
State	:	CO
Zip	:	80751-3915
Country	:	US
Telephone Number	:	970-522-0792
Fax Number	:

Authorized Official
Title or Position	:	SPED DIRECTOR
Name	:	DIANNE COX
Credential	:
Telephone Number	:	970-522-0792

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	08/22/2020

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