Healthcare Provider Details

I. General information

NPI: 1003031840
Provider Name (Legal Business Name): RANTOUL CITY SCHOOL 137
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E WABASH AVE
RANTOUL IL
61866-3013
US

IV. Provider business mailing address

400 E WABASH AVE
RANTOUL IL
61866-3013
US

V. Phone/Fax

Practice location:
  • Phone: 217-893-4171
  • Fax: 217-892-4313
Mailing address:
  • Phone: 217-893-4171
  • Fax: 217-892-4313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM TRANKINA
Title or Position: SUPERINTENDENT
Credential:
Phone: 217-893-4171