1154415032 NPI number — CLARK COUNTY EDUCATIONAL SERVICE CENTER

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 1154415032 NPI number — CLARK COUNTY EDUCATIONAL SERVICE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARK COUNTY EDUCATIONAL SERVICE CENTER
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:
1154415032
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:
30 WARDER ST.
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45504-2580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-325-7671
Provider Business Mailing Address Fax Number:
937-325-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 WARDER ST.
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45504-2580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-325-7671
Provider Business Practice Location Address Fax Number:
937-325-9915
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALLAND
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PHILLIP
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
937-325-7671

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0902232 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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