Provider Demographics
NPI:1184849952
Name:O'FALLON TOWNSHIP HIGH SCHOOL DIST 203
Entity Type:Organization
Organization Name:O'FALLON TOWNSHIP HIGH SCHOOL DIST 203
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-632-3507
Mailing Address - Street 1:600 S SMILEY ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2316
Mailing Address - Country:US
Mailing Address - Phone:618-632-3507
Mailing Address - Fax:618-632-9730
Practice Address - Street 1:600 S SMILEY ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2316
Practice Address - Country:US
Practice Address - Phone:618-632-3507
Practice Address - Fax:618-632-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)