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General NPI Number Information
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NPI Number | 1013132489
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Entity Type | Organization
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Legal Business Name | PRAIRIEVIEW OGDEN CCSD 197
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 106 N VINE ST
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City | ROYAL
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State | IL
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Zip | 61871
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Country | US
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Telephone | 217-583-3300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27
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City | ROYAL
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State | IL
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Zip | 61871-0027
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Country | US
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Telephone | 217-583-3300
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Fax |
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | VICTOR WHITE
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Credential |
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Telephone | 217-583-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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