Provider Demographics
NPI:1497922462
Name:COBDEN UNIT SCHOOL DISTRICT 17
Entity Type:Organization
Organization Name:COBDEN UNIT SCHOOL DISTRICT 17
Other - Org Name:COBDEN SCH UNIT DIST 17
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEITZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-893-2313
Mailing Address - Street 1:413 N APPLEKNOCKER ST
Mailing Address - Street 2:
Mailing Address - City:COBDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62920-2121
Mailing Address - Country:US
Mailing Address - Phone:618-893-2313
Mailing Address - Fax:618-893-4772
Practice Address - Street 1:413 N APPLEKNOCKER ST
Practice Address - Street 2:
Practice Address - City:COBDEN
Practice Address - State:IL
Practice Address - Zip Code:62920-2121
Practice Address - Country:US
Practice Address - Phone:618-893-2313
Practice Address - Fax:618-893-4772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
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=========6292001Medicaid