Provider Demographics
NPI:1467623728
Name:ANNA COMM CONSOLIDATED DIST 37
Entity Type:Organization
Organization Name:ANNA COMM CONSOLIDATED DIST 37
Other - Org Name:ANNA CC SCH DIST 37
Other - Org Type:Other Name
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-833-6812
Mailing Address - Street 1:301 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1126
Mailing Address - Country:US
Mailing Address - Phone:618-833-6812
Mailing Address - Fax:618-833-3205
Practice Address - Street 1:301 S GREEN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1126
Practice Address - Country:US
Practice Address - Phone:618-833-6812
Practice Address - Fax:618-833-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
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=========6290601Medicaid