MEDICARE: ZEIGLER ROYALTON COMMTY

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)	261QS100X	IL

General Provider Information

NPI Number	:	1588794929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZEIGLER ROYALTON COMMTY

Provider Business Mailing Address
First Line	:	PO BOX 38
Second Line	:
City	:	ZEIGLER
State	:	IL
Zip	:	62999-0038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4989 STATE HIGHWAY 148
Second Line	:
City	:	MULKEYTOWN
State	:	IL
Zip	:	62865-3296
Country	:	US
Telephone Number	:	618-596-5841
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	GEORGE WILKERSON
Credential	:
Telephone Number	:	618-596-5841

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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