MEDICARE: POMEROY SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073531182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POMEROY SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	1221 10TH ST
Second Line	:	PO BOX 950
City	:	POMEROY
State	:	WA
Zip	:	99347
Country	:	US
Telephone Number	:	509-843-1331
Fax Number	:	509-843-8202

Provider Business Practice Location Address
First Line	:	1221 10TH ST
Second Line	:
City	:	POMEROY
State	:	WA
Zip	:	99347
Country	:	US
Telephone Number	:	509-843-1331
Fax Number	:	509-843-8202

Authorized Official
Title or Position	:	ADMIN. OF SPECIAL SERVICES
Name	:	MR. FRED R KNEBEL
Credential	:	M.ED.
Telephone Number	:	509-843-1331

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	08/22/2020

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Directions to “POMEROY SCHOOL DISTRICT ” Practice Location

Language	Start Address	Practice Location

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