MEDICARE: CANNELTON CITY SCHOOL CORP

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)

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	:	1255651055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANNELTON CITY SCHOOL CORP

Provider Business Mailing Address
First Line	:	125 S 6TH ST
Second Line	:
City	:	CANNELTON
State	:	IN
Zip	:	47520-1205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S 6TH ST
Second Line	:
City	:	CANNELTON
State	:	IN
Zip	:	47520-1205
Country	:	US
Telephone Number	:	812-547-2637
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MELISSA EMBRY
Credential	:
Telephone Number	:	812-547-2637

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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Directions to “CANNELTON CITY SCHOOL CORP ” Practice Location

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