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NPI Code Detail

MEDICARE: ROOSEVELT ELEMENTARY SCHOOL DISTRICT #66

MEDICARE: ROOSEVELT ELEMENTARY SCHOOL DISTRICT #66
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
1390200000XStudent in an Organized Health Care Education/Training Program554841AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982724480
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOSEVELT ELEMENTARY SCHOOL DISTRICT #66
Provider Business Mailing Address
First Line : 6218 S 7TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-4211
Country : US
Telephone Number : 602-243-4866
Fax Number : 602-304-3132
Provider Business Practice Location Address
First Line : 6218 S 7TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-4211
Country : US
Telephone Number : 602-243-4866
Fax Number : 602-304-3132
Authorized Official
Title or Position : MEDICAID COORDINATOR
Name : MRS. THERESA W HALE
Credential :
Telephone Number : 602-304-3117
Provider Enumeration Date : 03/29/2007
Last Update Date : 08/22/2020

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Directions to “ROOSEVELT ELEMENTARY SCHOOL DISTRICT #66 ” Practice Location

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