MEDICARE: FIRELANDS LOCAL 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	:	1942441407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRELANDS LOCAL SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	112 N LAKE ST.
Second Line	:
City	:	SOUTH AMHERST
State	:	OH
Zip	:	44001-2824
Country	:	US
Telephone Number	:	440-965-5701
Fax Number	:	440-986-5990

Provider Business Practice Location Address
First Line	:	112 N LAKE ST.
Second Line	:
City	:	SOUTH AMHERST
State	:	OH
Zip	:	44001-2824
Country	:	US
Telephone Number	:	440-965-5701
Fax Number	:	440-986-5990

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. ROBERT (BRAD) B. MCCRACKEN
Credential	:
Telephone Number	:	440-965-5701

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	03/30/2012

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