MEDICARE: WEST OAK LANE CHARTER 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)		PA

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	:	1548462146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST OAK LANE CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	7115 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1136
Country	:	US
Telephone Number	:	215-927-7995
Fax Number	:	215-927-7980

Provider Business Practice Location Address
First Line	:	7115 STENTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19138-1136
Country	:	US
Telephone Number	:	215-927-7995
Fax Number	:	215-927-7980

Authorized Official
Title or Position	:	CAO
Name	:	MRS. ROBIN A CONBOY
Credential	:
Telephone Number	:	215-927-7995

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

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Directions to “WEST OAK LANE CHARTER SCHOOL ” Practice Location

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