Provider Demographics
NPI:1275703191
Name:TAMAROA S D #5
Entity Type:Organization
Organization Name:TAMAROA S D #5
Other - Org Name:TAMAROA SCHOOL DISTRICT 5
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-496-5513
Mailing Address - Street 1:200 WEST MAIN STREET
Mailing Address - Street 2:PO BOX 175
Mailing Address - City:TAMAROA
Mailing Address - State:IL
Mailing Address - Zip Code:62888-0175
Mailing Address - Country:US
Mailing Address - Phone:618-496-5513
Mailing Address - Fax:618-496-3911
Practice Address - Street 1:200 WEST MAIN STEET
Practice Address - Street 2:
Practice Address - City:TAMAROA
Practice Address - State:IL
Practice Address - Zip Code:62888
Practice Address - Country:US
Practice Address - Phone:618-496-5513
Practice Address - Fax:618-496-3911
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 Licenses
StateLicense IDTaxonomies
IL261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6288801Medicaid