Provider Demographics
NPI:1649418054
Name:SOUTH MADISON COMMUNITY SCHOOL CORPORATION
Entity Type:Organization
Organization Name:SOUTH MADISON COMMUNITY SCHOOL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WARMKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-778-2152
Mailing Address - Street 1:203 S HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-8590
Mailing Address - Country:US
Mailing Address - Phone:765-778-2152
Mailing Address - Fax:
Practice Address - Street 1:203 S HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8590
Practice Address - Country:US
Practice Address - Phone:765-778-2152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100197830Medicaid