MEDICARE: IOSCO REGIONAL EDUCATIONAL SERVICE AGENCY

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)		MI

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	:	1487664702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOSCO REGIONAL EDUCATIONAL SERVICE AGENCY

Provider Business Mailing Address
First Line	:	27 N REMPERT RD
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9752
Country	:	US
Telephone Number	:	989-362-3006
Fax Number	:	989-362-9076

Provider Business Practice Location Address
First Line	:	27 N REMPERT RD
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9752
Country	:	US
Telephone Number	:	989-362-3006
Fax Number	:	989-362-9076

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. THOMAS CALDWELL
Credential	:	PHD
Telephone Number	:	989-362-3006

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/21/2022

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