MEDICARE: EDMESTON CENTRAL SCHOOL

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	:	1306998083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDMESTON CENTRAL SCHOOL

Provider Business Mailing Address
First Line	:	PO BOX 5129
Second Line	:	11 NORTH STREET
City	:	EDMESTON
State	:	NY
Zip	:	13335-0529
Country	:	US
Telephone Number	:	607-965-8931
Fax Number	:	607-965-8942

Provider Business Practice Location Address
First Line	:	1113 NORTH STREET
Second Line	:
City	:	EDMESTON
State	:	NY
Zip	:	13335-0529
Country	:	US
Telephone Number	:	607-965-8931
Fax Number	:	607-965-8942

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL EDUCATION
Name	:	MARYELLEN BATES
Credential	:
Telephone Number	:	607-965-8931

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

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