MEDICARE: ST. JOHNS UNIFIED SCHOOL DISTRICT

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	:	1205974862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOHNS UNIFIED SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	13TH WEST, 450 SOUTH
Second Line	:	P.O. BOX 3030
City	:	ST. JOHNS
State	:	AZ
Zip	:	85936-3030
Country	:	US
Telephone Number	:	928-337-2255
Fax Number	:	928-337-2263

Provider Business Practice Location Address
First Line	:	13TH WEST, 450 SOUTH
Second Line	:
City	:	ST. JOHNS
State	:	AZ
Zip	:	85936-3030
Country	:	US
Telephone Number	:	928-337-2255
Fax Number	:	928-337-2263

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. LARRY HEAP
Credential	:
Telephone Number	:	928-337-2255

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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