Provider Demographics
NPI:1033253216
Name:M.S.D. OF WASHINGTON TOWNSHIP
Entity Type:Organization
Organization Name:M.S.D. OF WASHINGTON TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF BUSINESS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:LICATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-205-3332
Mailing Address - Street 1:8550 WOODFIELD CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2478
Mailing Address - Country:US
Mailing Address - Phone:317-205-3332
Mailing Address - Fax:317-205-3384
Practice Address - Street 1:8550 WOODFIELD CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2478
Practice Address - Country:US
Practice Address - Phone:317-205-3332
Practice Address - Fax:317-205-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100198400AMedicaid