MEDICARE: TRIAD LOCAL SCHOOLS

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	:	1154560712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIAD LOCAL SCHOOLS

Provider Business Mailing Address
First Line	:	7920 BRUSH LAKE RD
Second Line	:
City	:	NORTH LEWISBURG
State	:	OH
Zip	:	43060-9617
Country	:	US
Telephone Number	:	937-826-4004
Fax Number	:

Provider Business Practice Location Address
First Line	:	7920 BRUSH LAKE RD
Second Line	:
City	:	NORTH LEWISBURG
State	:	OH
Zip	:	43060-9617
Country	:	US
Telephone Number	:	937-826-4004
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS
Name	:	CONNIE S COHN
Credential	:
Telephone Number	:	937-826-4004

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	02/05/2009

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Directions to “TRIAD LOCAL SCHOOLS ” Practice Location

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