MEDICARE: GRANDVIEW CONSOLIDATED SCHOOL DISTRICT #4

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)		MO

General Provider Information

NPI Number	:	1538363882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRANDVIEW CONSOLIDATED SCHOOL DISTRICT #4

Provider Business Mailing Address
First Line	:	616 NE MIMOSA DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64086-3473
Country	:	US
Telephone Number	:	816-554-9493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 HIGH GROVE RD
Second Line	:
City	:	GRANDVIEW
State	:	MO
Zip	:	64030-2473
Country	:	US
Telephone Number	:	816-316-5000
Fax Number	:

Authorized Official
Title or Position	:	MEDICAID COORDINATOR
Name	:	MRS. PEGGY HUGHES
Credential	:
Telephone Number	:	816-316-5000

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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