MEDICARE: NEW KNOXVILLE LOCAL SCHOOL

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	:	1811141310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW KNOXVILLE LOCAL SCHOOL

Provider Business Mailing Address
First Line	:	345 S. MAIN ST.
Second Line	:
City	:	NEW KNOXVILLE
State	:	OH
Zip	:	45871-0476
Country	:	US
Telephone Number	:	419-753-2431
Fax Number	:	419-753-2333

Provider Business Practice Location Address
First Line	:	345 S. MAIN ST.
Second Line	:
City	:	NEW KNOXVILLE
State	:	OH
Zip	:	45871-0476
Country	:	US
Telephone Number	:	419-753-2431
Fax Number	:	419-753-2333

Authorized Official
Title or Position	:	TREASURER
Name	:	MARCIA A WIERWILLE
Credential	:
Telephone Number	:	419-753-2431

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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