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General NPI Number Information
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NPI Number | 1467623728
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Entity Type | Organization
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Legal Business Name | ANNA COMM CONSOLIDATED DIST 37
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 301 S GREEN ST
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City | ANNA
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State | IL
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Zip | 62906-1126
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Country | US
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Telephone | 618-833-6812
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Fax | 618-833-3205
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Provider Business Mailing Address
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Address Line | 301 S GREEN ST
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City | ANNA
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State | IL
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Zip | 62906-1126
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Country | US
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Telephone | 618-833-6812
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Fax | 618-833-3205
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Authorized Official
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Title or Position | BOOKKEEPER
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Name | MRS. KATHY D EAVES
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Credential |
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Telephone | 618-833-6812
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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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