Provider Demographics
NPI:1194754200
Name:NEWBERRY COUNTY SCHOOL DISTRICT
Entity type:Organization
Organization Name:NEWBERRY COUNTY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPT. FOR OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-321-2600
Mailing Address - Street 1:1539 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2831
Mailing Address - Country:US
Mailing Address - Phone:803-321-2600
Mailing Address - Fax:803-321-2013
Practice Address - Street 1:1539 MARTIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2831
Practice Address - Country:US
Practice Address - Phone:803-321-2600
Practice Address - Fax:803-321-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCW01410SC1Medicaid