MEDICARE: PALOS HEIGHTS SCHOOL DISTRICT 128

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	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1922143965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALOS HEIGHTS SCHOOL DISTRICT 128

Provider Business Mailing Address
First Line	:	12809 S MCVICKERS AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2351
Country	:	US
Telephone Number	:	708-597-9040
Fax Number	:

Provider Business Practice Location Address
First Line	:	12809 S MCVICKERS AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-2351
Country	:	US
Telephone Number	:	708-597-9040
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MRS. THERESA SAK
Credential	:	DR
Telephone Number	:	708-597-9040

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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