Provider Demographics
NPI:1538322540
Name:MEDWAY SCHOOL DEPARTMENT
Entity Type:Organization
Organization Name:MEDWAY SCHOOL DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DISSELKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-746-3514
Mailing Address - Street 1:45 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:EAST MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04430-1150
Mailing Address - Country:US
Mailing Address - Phone:207-746-3514
Mailing Address - Fax:207-746-3516
Practice Address - Street 1:45 NORTH ST
Practice Address - Street 2:
Practice Address - City:EAST MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04430-1150
Practice Address - Country:US
Practice Address - Phone:207-746-3514
Practice Address - Fax:207-746-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)