MEDICARE: BERRIEN COUNTY 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)

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	:	1780618819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRIEN COUNTY INTERMEDIATE SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	711 ST JOSEPH AVE
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1583
Country	:	US
Telephone Number	:	269-471-1772
Fax Number	:	269-471-2941

Provider Business Practice Location Address
First Line	:	711 SAINT JOSEPH AVE
Second Line	:
City	:	BERRIEN SPRINGS
State	:	MI
Zip	:	49103-1583
Country	:	US
Telephone Number	:	269-471-1772
Fax Number	:	269-471-2941

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. JEFFREY SIEGEL
Credential	:
Telephone Number	:	269-471-7725

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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