MEDICARE: BLOOMFIELD-MESPO LOCAL 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)		OH

General Provider Information

NPI Number	:	1730328519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMFIELD-MESPO LOCAL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	2077 PARK WEST RD
Second Line	:
City	:	NORTH BLOOMFIELD
State	:	OH
Zip	:	44450-9702
Country	:	US
Telephone Number	:	440-685-4722
Fax Number	:	440-685-4751

Provider Business Practice Location Address
First Line	:	2077 PARK WEST RD
Second Line	:
City	:	NORTH BLOOMFIELD
State	:	OH
Zip	:	44450-9702
Country	:	US
Telephone Number	:	440-685-4722
Fax Number	:	440-685-4751

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. WILLIAM DAUGHERTY SR.
Credential	:
Telephone Number	:	440-685-4722

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/18/2009

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