MEDICARE: PARAMOUNT ONLINE ACADEMY

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	:	1124794490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAMOUNT ONLINE ACADEMY

Provider Business Mailing Address
First Line	:	1203 E ST CLAIR ST
Second Line	:	DOOR 7
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202
Country	:	US
Telephone Number	:	317-519-4588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 E ST CLAIR ST
Second Line	:	DOOR 7
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202
Country	:	US
Telephone Number	:	317-519-4588
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JESSICA MONK
Credential	:
Telephone Number	:	317-519-4588

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	08/18/2021

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