Provider Demographics
NPI:1942316534
Name:SHELBYVILLE COMM UNIT SCHOOL DIST. 4
Entity Type:Organization
Organization Name:SHELBYVILLE COMM UNIT SCHOOL DIST. 4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-774-4626
Mailing Address - Street 1:720 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1334
Mailing Address - Country:US
Mailing Address - Phone:217-774-4626
Mailing Address - Fax:217-774-2521
Practice Address - Street 1:720 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1334
Practice Address - Country:US
Practice Address - Phone:217-774-4626
Practice Address - Fax:217-774-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid