Healthcare Provider Details

I. General information

NPI: 1972781441
Provider Name (Legal Business Name): THOMPSONVILLE COMMUNITY DISTRICT 174
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21135 SHAWNEETOWN RD
THOMPSONVILLE IL
62890-1035
US

IV. Provider business mailing address

21135 SHAWNEETOWN RD
THOMPSONVILLE IL
62890-1035
US

V. Phone/Fax

Practice location:
  • Phone: 618-627-2301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number261QS1000X
License Number State

VIII. Authorized Official

Name: SHERRIE MURPHY
Title or Position: ADM. ASSISTANT
Credential:
Phone: 618-439-7231