MEDICARE: ST. BERNARD-ELMWOOD PLACE CITY SCHOOLS

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	310 0432	OTHER	OH	OHIO CABS

General Provider Information

NPI Number	:	1568609980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. BERNARD-ELMWOOD PLACE CITY SCHOOLS

Provider Business Mailing Address
First Line	:	105 WASHINGTON AVE
Second Line	:
City	:	SAINT BERNARD
State	:	OH
Zip	:	45217-1317
Country	:	US
Telephone Number	:	513-482-7124
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 WASHINGTON AVE
Second Line	:
City	:	SAINT BERNARD
State	:	OH
Zip	:	45217-1317
Country	:	US
Telephone Number	:	513-482-7124
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. MICHAEL MAYS
Credential	:
Telephone Number	:	513-482-7124

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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