=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730324609
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUCUS LOCAL SCHOOLS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2008
-----------------------------------------------------
Last Update Date | 12/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 84 LUCAS NORTH RD
-----------------------------------------------------
City | LUCAS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44843-9532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-892-2338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 84 LUCAS NORTH RD
-----------------------------------------------------
City | LUCAS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44843-9532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-892-2338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | MR. STEVEN E DICKERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-892-2338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------