MEDICARE: PLUMAS LAKE ELEMENTARY 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)

General Provider Information

NPI Number	:	1083366702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUMAS LAKE ELEMENTARY SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	2743 PLUMAS SCHOOL RD
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-8827
Country	:	US
Telephone Number	:	530-743-4428
Fax Number	:	530-743-1408

Provider Business Practice Location Address
First Line	:	2743 PLUMAS SCHOOL RD
Second Line	:
City	:	PLUMAS LAKE
State	:	CA
Zip	:	95961-8827
Country	:	US
Telephone Number	:	530-743-4428
Fax Number	:	530-743-1408

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. JEFF ROBERTS
Credential	:
Telephone Number	:	530-742-4428

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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