Provider Demographics
NPI:1578609574
Name:EDWARDS-KNOX CENTRAL SCHOOL
Entity Type:Organization
Organization Name:EDWARDS-KNOX CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-347-3410
Mailing Address - Street 1:2512 COUNTY RT. 24
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:NY
Mailing Address - Zip Code:13684
Mailing Address - Country:US
Mailing Address - Phone:315-347-3410
Mailing Address - Fax:
Practice Address - Street 1:2512 COUNTY RT. 24
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:NY
Practice Address - Zip Code:13684
Practice Address - Country:US
Practice Address - Phone:315-347-3410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379684Medicaid