MEDICARE: DESOTO COUNTY SCHOOL BOARD

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	:	1982768776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESOTO COUNTY SCHOOL BOARD

Provider Business Mailing Address
First Line	:	530 LASOLONA AVE
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-4911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 LASOLONA AVE
Second Line	:
City	:	ARCADIA
State	:	FL
Zip	:	34266-4911
Country	:	US
Telephone Number	:	863-494-4222
Fax Number	:

Authorized Official
Title or Position	:	ESE DIRECTOR
Name	:	ROOSEVELT JOHNSON
Credential	:
Telephone Number	:	863-494-4222

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/22/2020

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Directions to “DESOTO COUNTY SCHOOL BOARD ” Practice Location

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