1750452561 NPI number — MCINTOSH COUNTY BOARD OF EDUCATION

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 1750452561 NPI number — MCINTOSH COUNTY BOARD OF EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCINTOSH COUNTY BOARD OF EDUCATION
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:
1750452561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32096-0799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-565-2162
Provider Business Mailing Address Fax Number:
888-737-1652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PINE ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31305-9756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-565-2162
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VASSAR
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PROGRAM ADMINISTRATOR
Authorized Official Telephone Number:
800-565-2162

Provider Taxonomy Codes

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

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

  • Identifier: 000774947A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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