MEDICARE: NORTHEASTERN WAYNE SCHOOL CORPORATION

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	:	1093831935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEASTERN WAYNE SCHOOL CORPORATION

Provider Business Mailing Address
First Line	:	314 W MAIN ST
Second Line	:
City	:	FOUNTAIN CITY
State	:	IN
Zip	:	47341
Country	:	US
Telephone Number	:	765-847-2821
Fax Number	:	765-847-5355

Provider Business Practice Location Address
First Line	:	314 W MAIN ST
Second Line	:
City	:	FOUNTAIN CITY
State	:	IN
Zip	:	47341
Country	:	US
Telephone Number	:	765-847-2821
Fax Number	:	765-847-5355

Authorized Official
Title or Position	:	TREASURER
Name	:	MS. KAY REED
Credential	:
Telephone Number	:	765-847-2821

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/22/2020

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