Healthcare Provider Details

I. General information

NPI: 1831305028
Provider Name (Legal Business Name): JOHNSTON CITY COMM UNIT DIST 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 MONROE AVE
JOHNSTON CITY IL
62951-1566
US

IV. Provider business mailing address

1103 MONROE AVE
JOHNSTON CITY IL
62951-1566
US

V. Phone/Fax

Practice location:
  • Phone: 618-983-8021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: GARY SCHURZ
Title or Position: SUPERINTENDENT
Credential:
Phone: 618-983-8021