MEDICARE: SOUTH EASTERN 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)		PA

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	:	1982861449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH EASTERN SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	377 MAIN ST
Second Line	:
City	:	FAWN GROVE
State	:	PA
Zip	:	17321-9514
Country	:	US
Telephone Number	:	717-382-4220
Fax Number	:	717-382-1326

Provider Business Practice Location Address
First Line	:	377 MAIN ST
Second Line	:
City	:	FAWN GROVE
State	:	PA
Zip	:	17321-9514
Country	:	US
Telephone Number	:	717-382-4220
Fax Number	:	717-382-1326

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	PAULA K DENTON
Credential	:
Telephone Number	:	717-382-4843

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/22/2008

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Directions to “SOUTH EASTERN SCHOOL DISTRICT ” Practice Location

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