MEDICARE: GENESEE INTERMEDIATE 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)

General Provider Information

NPI Number	:	1750390720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESEE INTERMEDIATE SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	2413 W MAPLE AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3429
Country	:	US
Telephone Number	:	810-591-4936
Fax Number	:	810-591-4440

Provider Business Practice Location Address
First Line	:	2413 W MAPLE AVE
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-3429
Country	:	US
Telephone Number	:	810-591-4936
Fax Number	:	810-591-4440

Authorized Official
Title or Position	:	SUPERVISOR, STUDENT DATA MANAGEMENT
Name	:	MS. DEBRA K MARSHALL
Credential	:
Telephone Number	:	810-591-4936

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

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Directions to “GENESEE INTERMEDIATE SCHOOL DISTRICT ” Practice Location

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