Healthcare Provider Details

I. General information

NPI: 1326168030
Provider Name (Legal Business Name): RANTOUL TWP HS 193
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S SHELDON ST
RANTOUL IL
61866-2431
US

IV. Provider business mailing address

200 S SHELDON ST
RANTOUL IL
61866-2431
US

V. Phone/Fax

Practice location:
  • Phone: 217-892-2151
  • Fax:
Mailing address:
  • Phone: 217-892-2151
  • Fax:

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: MR. DAVID REQUA
Title or Position: SUPERINTENDENT
Credential:
Phone: 217-892-2151