MEDICARE: COLUMBIA COUNTY 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	:	1740118314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA COUNTY SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	372 WEST DUVAL STREET
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-3990
Country	:	US
Telephone Number	:	386-755-8012
Fax Number	:

Provider Business Practice Location Address
First Line	:	372 WEST DUVAL STREET
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-3990
Country	:	US
Telephone Number	:	386-755-8012
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BONNIE PENNER
Credential	:
Telephone Number	:	386-755-8000

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “COLUMBIA COUNTY SCHOOL DISTRICT ” Practice Location

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