Provider Demographics
NPI:1952473191
Name:FORT MILL SCHOOL DISTRICT #4
Entity Type:Organization
Organization Name:FORT MILL SCHOOL DISTRICT #4
Other - Org Name:YORK SCHOOL DISTRICT #4
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLICUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-548-2527
Mailing Address - Street 1:120 E ELLIOTT ST
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-1848
Mailing Address - Country:US
Mailing Address - Phone:803-548-2527
Mailing Address - Fax:803-548-8273
Practice Address - Street 1:120 E ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-1848
Practice Address - Country:US
Practice Address - Phone:803-548-2527
Practice Address - Fax:803-548-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
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
SCSD4604Medicaid