MEDICARE: BUCKEYE LOCAL 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)		OH

General Provider Information

NPI Number	:	1467631846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE LOCAL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	3436 EDGEWOOD DR
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-5967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3436 EDGEWOOD DR
Second Line	:
City	:	ASHTABULA
State	:	OH
Zip	:	44004-5967
Country	:	US
Telephone Number	:	440-998-2017
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	SHERRY WENTWORTH
Credential	:
Telephone Number	:	440-998-2017

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	10/28/2008

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Directions to “BUCKEYE LOCAL SCHOOL DISTRICT ” Practice Location

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