Provider Demographics
NPI:1033243712
Name:MIAMI TRACE LOCAL SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MIAMI TRACE LOCAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURERCFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:740-335-3010
Mailing Address - Street 1:3818 STATE ROUTE 41 NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-9184
Mailing Address - Country:US
Mailing Address - Phone:740-335-3010
Mailing Address - Fax:
Practice Address - Street 1:3818 STATE ROUTE 41 NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-9184
Practice Address - Country:US
Practice Address - Phone:740-335-3010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2895710Medicaid