Provider Demographics
NPI:1205006129
Name:PINCKNEYVILLE SCHOOL DISTRICT #50
Entity Type:Organization
Organization Name:PINCKNEYVILLE SCHOOL DISTRICT #50
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-357-9096
Mailing Address - Street 1:301 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-1370
Mailing Address - Country:US
Mailing Address - Phone:618-357-9096
Mailing Address - Fax:618-357-8731
Practice Address - Street 1:301 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1370
Practice Address - Country:US
Practice Address - Phone:618-357-9096
Practice Address - Fax:618-357-8731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6227401Medicaid