Provider Demographics
NPI:1598939209
Name:ANNA JONESBORO COMMUNITY
Entity Type:Organization
Organization Name:ANNA JONESBORO COMMUNITY
Other - Org Name:ANNA JONESBORO COMM HS DIST 81
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-833-8502
Mailing Address - Street 1:608 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-1247
Mailing Address - Country:US
Mailing Address - Phone:618-833-8502
Mailing Address - Fax:618-833-4239
Practice Address - Street 1:608 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-1247
Practice Address - Country:US
Practice Address - Phone:618-833-8502
Practice Address - Fax:618-833-4239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
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