Healthcare Provider Details

I. General information

NPI: 1013024165
Provider Name (Legal Business Name): MATTOON COMM UNIT SCHOOL DIST 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CHARLESTON AVE
MATTOON IL
61938-3936
US

IV. Provider business mailing address

1701 CHARLESTON AVE
MATTOON IL
61938-3936
US

V. Phone/Fax

Practice location:
  • Phone: 217-238-8850
  • Fax: 217-238-8855
Mailing address:
  • Phone: 217-238-8850
  • Fax: 217-238-8855

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: MR. LARRY LILLY
Title or Position: SUPERINTENDENT
Credential:
Phone: 217-238-8850