MEDICARE: HERITAGE CUSD 8

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	:	1962629808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE CUSD 8

Provider Business Mailing Address
First Line	:	512 W 1ST ST
Second Line	:
City	:	HOMER
State	:	IL
Zip	:	61849-1215
Country	:	US
Telephone Number	:	217-834-3392
Fax Number	:	217-834-3392

Provider Business Practice Location Address
First Line	:	512 W 1ST ST
Second Line	:
City	:	HOMER
State	:	IL
Zip	:	61849-1215
Country	:	US
Telephone Number	:	217-893-2421
Fax Number	:	217-896-2715

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	ANDREW LARSON
Credential	:
Telephone Number	:	217-834-3392

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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Directions to “HERITAGE CUSD 8 ” Practice Location

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