Healthcare Provider Details

I. General information

NPI: 1053520304
Provider Name (Legal Business Name): NORRIS CITY-OMAHA-ENFIELD CSUD 3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

409 E 3RD ST
NORRIS CITY IL
62869-1069
US

IV. Provider business mailing address

409 E 3RD ST
NORRIS CITY IL
62869-1069
US

V. Phone/Fax

Practice location:
  • Phone: 618-378-3222
  • Fax: 618-378-3286
Mailing address:
  • Phone: 618-378-3222
  • Fax: 618-378-3286

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. MICHAEL PHELPS
Title or Position: SUPERINTENDENT
Credential:
Phone: 618-378-3222