MEDICARE: CLARK COUNTY EDUCATIONAL SERVICE CENTER

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	251K00000X	Public Health or Welfare Agency		OH

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	:	1154415032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARK COUNTY EDUCATIONAL SERVICE CENTER

Provider Business Mailing Address
First Line	:	30 WARDER ST.
Second Line	:	SUITE 120
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-2580
Country	:	US
Telephone Number	:	937-325-7671
Fax Number	:	937-325-9915

Provider Business Practice Location Address
First Line	:	30 WARDER ST.
Second Line	:	SUITE 120
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-2580
Country	:	US
Telephone Number	:	937-325-7671
Fax Number	:	937-325-9915

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. JOHN PHILLIP CALLAND
Credential	:
Telephone Number	:	937-325-7671

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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