Provider Demographics
NPI:1164833679
Name:INDIANA MATH AND SCIENCE ACADEMY WEST
Entity Type:Organization
Organization Name:INDIANA MATH AND SCIENCE ACADEMY WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMSA REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:SERQUITTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-252-3990
Mailing Address - Street 1:4575 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4575 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-3313
Practice Address - Country:US
Practice Address - Phone:317-252-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)