Provider Demographics
NPI:1104096932
Name:DONGOLA SCH UNIT DIST 66
Entity type:Organization
Organization Name:DONGOLA SCH UNIT DIST 66
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT/PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:GAYER
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:618-827-3841
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:DONGOLA
Mailing Address - State:IL
Mailing Address - Zip Code:62926-0190
Mailing Address - Country:US
Mailing Address - Phone:618-827-3841
Mailing Address - Fax:618-827-4641
Practice Address - Street 1:1000 HIGH ST.
Practice Address - Street 2:
Practice Address - City:DONGOLA
Practice Address - State:IL
Practice Address - Zip Code:62926-0190
Practice Address - Country:US
Practice Address - Phone:618-827-3841
Practice Address - Fax:618-827-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3760047396292601Medicaid