Provider Demographics
NPI:1942275649
Name:ANDERSON SCHOOL DISTRICT FOUR
Entity Type:Organization
Organization Name:ANDERSON SCHOOL DISTRICT FOUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-646-8000
Mailing Address - Street 1:315 E QUEEN ST
Mailing Address - Street 2:PO BOX 545
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-0545
Mailing Address - Country:US
Mailing Address - Phone:864-646-8000
Mailing Address - Fax:864-646-8555
Practice Address - Street 1:315 E QUEEN ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-0545
Practice Address - Country:US
Practice Address - Phone:864-646-8000
Practice Address - Fax:864-646-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSD0404Medicaid