MEDICARE: RIVERSIDE SCHOOL DISTRICT NO.

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	:	1811156375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE SCHOOL DISTRICT NO.

Provider Business Mailing Address
First Line	:	1414 S 51ST AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-8003
Country	:	US
Telephone Number	:	602-477-8900
Fax Number	:	602-272-8378

Provider Business Practice Location Address
First Line	:	1414 S 51ST AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-8003
Country	:	US
Telephone Number	:	602-477-8900
Fax Number	:	602-272-8378

Authorized Official
Title or Position	:	PAYROLL CLERK
Name	:	MRS. DONNA L TAYLOR
Credential	:
Telephone Number	:	602-477-8919

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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