MEDICARE: WAVERLY CU SCHOOL DIST 6

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)

General Provider Information

NPI Number	:	1740482207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAVERLY CU SCHOOL DIST 6

Provider Business Mailing Address
First Line	:	201 N MILLER ST
Second Line	:
City	:	WAVERLY
State	:	IL
Zip	:	62692-1041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N MILLER ST
Second Line	:
City	:	WAVERLY
State	:	IL
Zip	:	62692-1041
Country	:	US
Telephone Number	:	217-245-7174
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GINA ECKHOUSE
Credential	:
Telephone Number	:	217-245-7174

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

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