MEDICARE: COLORADO CITY UNIFIED SCHOOL DISTRICT #14

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	:	1386836625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO CITY UNIFIED SCHOOL DISTRICT #14

Provider Business Mailing Address
First Line	:	325 NORTH COOTONWOOD STREET
Second Line	:	P.O. BOX 309
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-0309
Country	:	US
Telephone Number	:	928-875-9032
Fax Number	:	928-875-8066

Provider Business Practice Location Address
First Line	:	325 NORTH COOTONWOOD STREET
Second Line	:
City	:	COLORADO CITY
State	:	AZ
Zip	:	86021-0309
Country	:	US
Telephone Number	:	928-875-9032
Fax Number	:	928-875-8066

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MS. CAROL K. TIMPSON
Credential	:
Telephone Number	:	928-875-9030

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	08/10/2007

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