Provider Demographics
NPI:1114965696
Name:SOUTHERN TIOGA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SOUTHERN TIOGA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR OF SPECIAL INSTRUCTION
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIKORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-638-2183
Mailing Address - Street 1:241 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOSSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16912-1125
Mailing Address - Country:US
Mailing Address - Phone:570-638-2183
Mailing Address - Fax:570-638-3099
Practice Address - Street 1:241 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOSSBURG
Practice Address - State:PA
Practice Address - Zip Code:16912-1125
Practice Address - Country:US
Practice Address - Phone:570-638-2183
Practice Address - Fax:570-638-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013925040001Medicaid