MEDICARE: WILSON CENTRAL 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	:	1306233960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON CENTRAL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	412 LAKE ST.
Second Line	:	P.O. BOX 648
City	:	WILSON
State	:	NY
Zip	:	14172-0648
Country	:	US
Telephone Number	:	716-751-9341
Fax Number	:	716-751-0008

Provider Business Practice Location Address
First Line	:	412 LAKE ST
Second Line	:
City	:	WILSON
State	:	NY
Zip	:	14172-9798
Country	:	US
Telephone Number	:	716-751-9341
Fax Number	:	716-751-0008

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL EDUCATION
Name	:	MR. MICHAEL A. CANCILLA JR.
Credential	:
Telephone Number	:	716-751-9341

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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