Provider Demographics
NPI:1619094364
Name:JONESBORO CC SCHOOL DIST 43
Entity Type:Organization
Organization Name:JONESBORO CC SCHOOL DIST 43
Other - Org Name:JONESBORO SCHOOL DISTRICT 43
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-833-6651
Mailing Address - Street 1:309 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62952
Mailing Address - Country:US
Mailing Address - Phone:618-833-6651
Mailing Address - Fax:618-833-8612
Practice Address - Street 1:309 COOK AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:IL
Practice Address - Zip Code:62952
Practice Address - Country:US
Practice Address - Phone:618-833-6651
Practice Address - Fax:618-833-8612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
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=========001Medicaid