Provider Demographics
NPI:1013024165
Name:MATTOON COMM UNIT SCHOOL DIST 2
Entity Type:Organization
Organization Name:MATTOON COMM UNIT SCHOOL DIST 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-238-8850
Mailing Address - Street 1:1701 CHARLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-3936
Mailing Address - Country:US
Mailing Address - Phone:217-238-8850
Mailing Address - Fax:217-238-8855
Practice Address - Street 1:1701 CHARLESTON AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-3936
Practice Address - Country:US
Practice Address - Phone:217-238-8850
Practice Address - Fax:217-238-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
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
IL=========002Medicaid