MEDICARE: PORT BYRON 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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477610624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT BYRON CENTRAL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	30 MAPLE AVE
Second Line	:
City	:	PORT BYRON
State	:	NY
Zip	:	13140-3404
Country	:	US
Telephone Number	:	315-776-5569
Fax Number	:	315-776-9824

Provider Business Practice Location Address
First Line	:	30 MAPLE AVE
Second Line	:
City	:	PORT BYRON
State	:	NY
Zip	:	13140-3404
Country	:	US
Telephone Number	:	315-776-5569
Fax Number	:	315-776-9824

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL PROGRAMS
Name	:	MS. RANDI LUDWIG
Credential	:
Telephone Number	:	315-776-5569

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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