Provider Demographics
NPI:1689722449
Name:MIDDLESBORO BOARD OF EDUCATION
Entity Type:Organization
Organization Name:MIDDLESBORO BOARD OF EDUCATION
Other - Org Name:MIDDLESBORO BOARD OF EDUCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:AVA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-242-8804
Mailing Address - Street 1:220 N 20TH ST
Mailing Address - Street 2:PO BOX 959
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-0959
Mailing Address - Country:US
Mailing Address - Phone:606-242-8800
Mailing Address - Fax:606-242-8805
Practice Address - Street 1:220 NORTH 20TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-0959
Practice Address - Country:US
Practice Address - Phone:606-242-8800
Practice Address - Fax:606-242-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21002034251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21002034Medicaid