MEDICARE: SANTIAM CANYON SCHOOL DISTRICT 129J

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	:	1639269780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTIAM CANYON SCHOOL DISTRICT 129J

Provider Business Mailing Address
First Line	:	150 SW EVERGREEN STREET
Second Line	:	PO BOX 197
City	:	MILL CITY
State	:	OR
Zip	:	97360-0197
Country	:	US
Telephone Number	:	503-897-2321
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 SW EVERGREEN STREET
Second Line	:
City	:	MILL CITY
State	:	OR
Zip	:	97360-0197
Country	:	US
Telephone Number	:	503-897-2321
Fax Number	:	503-897-4004

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	STEVE NIELSEN
Credential	:
Telephone Number	:	503-897-2321

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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