Provider Demographics
NPI:1154592780
Name:DU QUOIN COMMUNITY UNIT SCHOOL
Entity type:Organization
Organization Name:DU QUOIN COMMUNITY UNIT SCHOOL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DISTRICT BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-542-3856
Mailing Address - Street 1:845 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DU QUOIN
Mailing Address - State:IL
Mailing Address - Zip Code:62832-3871
Mailing Address - Country:US
Mailing Address - Phone:618-542-3856
Mailing Address - Fax:618-542-6614
Practice Address - Street 1:845 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:DU QUOIN
Practice Address - State:IL
Practice Address - Zip Code:62832-3871
Practice Address - Country:US
Practice Address - Phone:618-542-3856
Practice Address - Fax:618-542-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-04-20
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
IL=========6283201Medicaid