MEDICARE: MOMENCE DISTRICT #1

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	:	1841463437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOMENCE DISTRICT #1

Provider Business Mailing Address
First Line	:	415 N DIXIE HWY
Second Line	:
City	:	MOMENCE
State	:	IL
Zip	:	60954-1221
Country	:	US
Telephone Number	:	815-472-3501
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 N DIXIE HWY
Second Line	:
City	:	MOMENCE
State	:	IL
Zip	:	60954-1221
Country	:	US
Telephone Number	:	815-472-3501
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. PHILLIP SMITH
Credential	:
Telephone Number	:	815-472-3501

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/04/2008

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Directions to “MOMENCE DISTRICT #1 ” Practice Location

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