MEDICARE: FIELD COMMUNITY CONSOLIDATED SCHOOL

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)	376003399002	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	250410030040000	OTHER	IL	RCDT CODE

General Provider Information

NPI Number	:	1144358185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIELD COMMUNITY CONSOLIDATED SCHOOL

Provider Business Mailing Address
First Line	:	21075 N HAILS LN
Second Line	:
City	:	TEXICO
State	:	IL
Zip	:	62889-2932
Country	:	US
Telephone Number	:	618-755-4611
Fax Number	:	618-755-9701

Provider Business Practice Location Address
First Line	:	21075 N HAILS LN
Second Line	:
City	:	TEXICO
State	:	IL
Zip	:	62889-2932
Country	:	US
Telephone Number	:	618-755-4611
Fax Number	:	618-755-9701

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MS. GINA RAE ILBERY
Credential	:
Telephone Number	:	618-755-4611

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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Directions to “FIELD COMMUNITY CONSOLIDATED SCHOOL ” Practice Location

Language	Start Address	Practice Location

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