MEDICARE: BURRIS LABORATORY SCHOOL

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	:	1407984107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURRIS LABORATORY SCHOOL

Provider Business Mailing Address
First Line	:	2000 W UNIVERSITY AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47306-1062
Country	:	US
Telephone Number	:	765-285-1131
Fax Number	:	765-285-8620

Provider Business Practice Location Address
First Line	:	2000 W UNIVERSITY AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47306-1062
Country	:	US
Telephone Number	:	765-285-1131
Fax Number	:	765-285-8620

Authorized Official
Title or Position	:	SCHOOL PRINCIPAL
Name	:	DR. JAY MCGEE
Credential	:
Telephone Number	:	765-285-1131

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	08/22/2020

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