MEDICARE: EL PASO-GRIDLEY CUSD #11

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)

General Provider Information

NPI Number	:	1073733523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO-GRIDLEY CUSD #11

Provider Business Mailing Address
First Line	:	97 W 5TH ST
Second Line	:
City	:	EL PASO
State	:	IL
Zip	:	61738-1049
Country	:	US
Telephone Number	:	309-527-4410
Fax Number	:	309-527-4040

Provider Business Practice Location Address
First Line	:	97 W 5TH ST
Second Line	:
City	:	EL PASO
State	:	IL
Zip	:	61738-1049
Country	:	US
Telephone Number	:	309-527-4410
Fax Number	:	309-527-4040

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	WILLIAM JAMES
Credential	:
Telephone Number	:	309-527-4410

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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