Provider Demographics
NPI:1508824327
Name:MIDWESTERN INTERMEDIATE UNIT
Entity Type:Organization
Organization Name:MIDWESTERN INTERMEDIATE UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZZUOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-458-6700
Mailing Address - Street 1:453 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-2324
Mailing Address - Country:US
Mailing Address - Phone:724-458-6700
Mailing Address - Fax:724-458-5083
Practice Address - Street 1:453 MAPLE ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-2324
Practice Address - Country:US
Practice Address - Phone:724-458-6700
Practice Address - Fax:724-458-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000009520002Medicaid