MEDICARE: SOUTHERN LOCAL SCHOOL DISTRICT

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	:	1699808311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN LOCAL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	10397 STATE ROUTE 155 SE
Second Line	:
City	:	CORNING
State	:	OH
Zip	:	43730
Country	:	US
Telephone Number	:	740-394-2402
Fax Number	:

Provider Business Practice Location Address
First Line	:	10397 STATE ROUTE 155 SE
Second Line	:
City	:	CORNING
State	:	OH
Zip	:	43730
Country	:	US
Telephone Number	:	330-854-2291
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	BROOKE CHAMP
Credential	:
Telephone Number	:	740-721-0527

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	05/22/2024

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