1891816765 NPI number — MT. VERNON COMMUNITY SCHOOL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891816765 NPI number — MT. VERNON COMMUNITY SCHOOL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MT. VERNON COMMUNITY SCHOOL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891816765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1776 W STATE ROAD 234
Provider Second Line Business Mailing Address:
ONE SHOPPELL BLVD
Provider Business Mailing Address City Name:
FORTVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46040-9562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-485-3100
Provider Business Mailing Address Fax Number:
317-485-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1776 W STATE ROAD 234
Provider Second Line Business Practice Location Address:
ONE SHOPPELL BLVD
Provider Business Practice Location Address City Name:
FORTVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46040-9562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-485-3100
Provider Business Practice Location Address Fax Number:
317-485-3113
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BAUGH
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
317-485-3100

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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