MEDICARE: DONGOLA SCH UNIT DIST 66

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	261QS1000X	Student Health Clinic/Center		IL

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	:	1104096932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONGOLA SCH UNIT DIST 66

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	DONGOLA
State	:	IL
Zip	:	62926-0190
Country	:	US
Telephone Number	:	618-827-3841
Fax Number	:	618-827-4641

Provider Business Practice Location Address
First Line	:	1000 HIGH ST.
Second Line	:
City	:	DONGOLA
State	:	IL
Zip	:	62926-0190
Country	:	US
Telephone Number	:	618-827-3841
Fax Number	:	618-827-4641

Authorized Official
Title or Position	:	SUPERINTENDENT/PRINCIPAL
Name	:	MR. BRETT SHAWN GAYER
Credential	:	EDS
Telephone Number	:	618-827-3841

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/07/2008

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Directions to “DONGOLA SCH UNIT DIST 66 ” Practice Location

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