Provider Demographics
NPI:1619300340
Name:AUGUSTA IND. BOARD OF EDUCATION
Entity Type:Organization
Organization Name:AUGUSTA IND. BOARD OF EDUCATION
Other - Org Name:AUGUSTA IND. SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-756-2545
Mailing Address - Street 1:307 BRACKEN ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KY
Mailing Address - Zip Code:41002-1134
Mailing Address - Country:US
Mailing Address - Phone:606-756-2545
Mailing Address - Fax:606-756-2149
Practice Address - Street 1:307 BRACKEN ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:KY
Practice Address - Zip Code:41002-1134
Practice Address - Country:US
Practice Address - Phone:606-756-2545
Practice Address - Fax:606-756-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21000112Medicaid