Provider Demographics
NPI:1699830943
Name:ODESSA-MONTOUR CENTRAL SCHOOL
Entity Type:Organization
Organization Name:ODESSA-MONTOUR CENTRAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-535-7267
Mailing Address - Street 1:300 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:NY
Mailing Address - Zip Code:14869
Mailing Address - Country:US
Mailing Address - Phone:607-594-3341
Mailing Address - Fax:607-535-7802
Practice Address - Street 1:300 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:NY
Practice Address - Zip Code:14869
Practice Address - Country:US
Practice Address - Phone:607-594-3341
Practice Address - Fax:607-535-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379533Medicaid