MEDICARE: ALLEGAN COUNTY INTERMEDIATE SCHOOL DISTRICT

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)

General Provider Information

NPI Number	:	1144265620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGAN COUNTY INTERMEDIATE SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	310 THOMAS ST
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-9158
Country	:	US
Telephone Number	:	269-673-2161
Fax Number	:	269-673-2361

Provider Business Practice Location Address
First Line	:	310 THOMAS ST
Second Line	:
City	:	ALLEGAN
State	:	MI
Zip	:	49010-9158
Country	:	US
Telephone Number	:	269-673-2161
Fax Number	:	269-673-2361

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. RONALD L FULLER
Credential	:
Telephone Number	:	269-673-2161

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	08/22/2020

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