MEDICARE: COAL CITY CU SCHOOL DIST 1

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	:	1346442803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COAL CITY CU SCHOOL DIST 1

Provider Business Mailing Address
First Line	:	100 S BAIMA ST
Second Line	:
City	:	COAL CITY
State	:	IL
Zip	:	60416-1663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S BAIMA ST
Second Line	:
City	:	COAL CITY
State	:	IL
Zip	:	60416-1663
Country	:	US
Telephone Number	:	815-942-5780
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SCOTT SAND
Credential	:
Telephone Number	:	815-942-5780

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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