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General NPI Number Information
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NPI Number | 1104096932
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Entity Type | Organization
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Legal Business Name | DONGOLA SCH UNIT DIST 66
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 1000 HIGH ST.
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City | DONGOLA
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State | IL
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Zip | 62926-0190
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Country | US
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Telephone | 618-827-3841
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Fax | 618-827-4641
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | DONGOLA
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State | IL
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Zip | 62926-0190
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Country | US
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Telephone | 618-827-3841
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Fax | 618-827-4641
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Authorized Official
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Title or Position | SUPERINTENDENT/PRINCIPAL
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Name | MR. BRETT SHAWN GAYER
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Credential | EDS
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Telephone | 618-827-3841
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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 | IL
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