MEDICARE: WOOD RIVER HARTFORD SCH DIST 15

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	:	1356392047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOOD RIVER HARTFORD SCH DIST 15

Provider Business Mailing Address
First Line	:	501 E LORENA AVE
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2123
Country	:	US
Telephone Number	:	618-254-0607
Fax Number	:	618-254-9048

Provider Business Practice Location Address
First Line	:	501 E LORENA AVE
Second Line	:
City	:	WOOD RIVER
State	:	IL
Zip	:	62095-2123
Country	:	US
Telephone Number	:	618-254-0607
Fax Number	:	618-254-9048

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. MICHAEL LOFTUS
Credential	:
Telephone Number	:	618-254-0607

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/22/2020

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