Provider Demographics
NPI:1619278058
Name:ORANGEBURG CONSOLIDATED SCHOOL DISTRICT 5
Entity Type:Organization
Organization Name:ORANGEBURG CONSOLIDATED SCHOOL DISTRICT 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-533-7970
Mailing Address - Street 1:578 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-5022
Mailing Address - Country:US
Mailing Address - Phone:803-533-7970
Mailing Address - Fax:803-535-1610
Practice Address - Street 1:578 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-5022
Practice Address - Country:US
Practice Address - Phone:803-533-7970
Practice Address - Fax:803-535-1610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25130000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSD3805Medicaid