MEDICARE: GREENWOOD SCHOOL DISTRICT 52

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	390200000X	Student in an Organized Health Care Education/Training Program

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	:	1588684823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENWOOD SCHOOL DISTRICT 52

Provider Business Mailing Address
First Line	:	605 JOHNSTON RD
Second Line	:
City	:	NINETY SIX
State	:	SC
Zip	:	29666-1417
Country	:	US
Telephone Number	:	864-543-3100
Fax Number	:	864-543-3704

Provider Business Practice Location Address
First Line	:	605 JOHNSTON RD
Second Line	:
City	:	NINETY SIX
State	:	SC
Zip	:	29666-1417
Country	:	US
Telephone Number	:	864-543-3100
Fax Number	:	864-543-3704

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	DR. DAN POWELL
Credential	:
Telephone Number	:	864-543-3100

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/22/2020

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Directions to “GREENWOOD SCHOOL DISTRICT 52 ” Practice Location

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