Healthcare Provider Details

I. General information

NPI: 1285831701
Provider Name (Legal Business Name): HICKSVILLE EXEMPTED VILLAGE SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E SMITH ST
HICKSVILLE OH
43526-1110
US

IV. Provider business mailing address

105 E SMITH ST
HICKSVILLE OH
43526-1110
US

V. Phone/Fax

Practice location:
  • Phone: 419-542-7665
  • Fax: 419-542-8534
Mailing address:
  • Phone: 419-542-7665
  • Fax: 419-542-8534

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: DR. KEVIN S. MILLER
Title or Position: SUPERINTENDENT
Credential: ED.D.
Phone: 419-542-7665