Provider Demographics
NPI:1124121173
Name:MSD OF SHAKAMAK
Entity type:Organization
Organization Name:MSD OF SHAKAMAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:G
Authorized Official - Last Name:EPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-665-3550
Mailing Address - Street 1:RR 2 BOX 42
Mailing Address - Street 2:BOX 42
Mailing Address - City:JASONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47438-9511
Mailing Address - Country:US
Mailing Address - Phone:812-665-3550
Mailing Address - Fax:812-665-5001
Practice Address - Street 1:RR 2 BOX 42
Practice Address - Street 2:
Practice Address - City:JASONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47438-9511
Practice Address - Country:US
Practice Address - Phone:812-665-3550
Practice Address - Fax:812-665-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)