Provider Demographics
NPI:1164649349
Name:CITY OF AUGUSTA
Entity Type:Organization
Organization Name:CITY OF AUGUSTA
Other - Org Name:AUGUSTA SCHOOL DEPARTMENT OR AUGUSTA SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:JURDAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-2487
Mailing Address - Street 1:12 GEDNEY ST
Mailing Address - Street 2:SUPERINTENDENT'S OFFICE
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-4440
Mailing Address - Country:US
Mailing Address - Phone:207-626-2468
Mailing Address - Fax:207-626-2444
Practice Address - Street 1:12 GEDNEY ST
Practice Address - Street 2:SUPERINTENDENT'S OFFICE
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4440
Practice Address - Country:US
Practice Address - Phone:207-626-2464
Practice Address - Fax:207-626-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135930100Medicaid
135930100OtherLEA PROVIDER ID