=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245384593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYONS CENTRAL SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 05/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 CLYDE RD
-----------------------------------------------------
City | LYONS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14489-9364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-946-2200
-----------------------------------------------------
Fax | 315-946-2205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 CLYDE RD
-----------------------------------------------------
City | LYONS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14489-9364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-946-2200
-----------------------------------------------------
Fax | 315-946-2205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICIAL
-----------------------------------------------------
Name | MR. MIKE PANGALLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-946-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------