=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851571749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN SIMON UNIFIED SCHOOL DISTRICT #18
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2007
-----------------------------------------------------
Last Update Date | 11/07/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2226 WEST BUSINESS I 10
-----------------------------------------------------
City | SAN SIMON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-845-2275
-----------------------------------------------------
Fax | 520-845-2480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 38
-----------------------------------------------------
City | SAN SIMON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85632-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-845-2275
-----------------------------------------------------
Fax | 520-845-2480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | DR. JOSEPH GUTHRIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 520-845-2275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------