Provider Demographics
NPI:1013132489
Name:PRAIRIEVIEW OGDEN CCSD 197
Entity Type:Organization
Organization Name:PRAIRIEVIEW OGDEN CCSD 197
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-583-3300
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:ROYAL
Mailing Address - State:IL
Mailing Address - Zip Code:61871-0027
Mailing Address - Country:US
Mailing Address - Phone:217-583-3300
Mailing Address - Fax:
Practice Address - Street 1:106 N VINE ST
Practice Address - Street 2:
Practice Address - City:ROYAL
Practice Address - State:IL
Practice Address - Zip Code:61871
Practice Address - Country:US
Practice Address - Phone:217-583-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health