Provider Demographics
NPI:1326188483
Name:UNION COUNTY SCHOOL DISTRICT #15
Entity type:Organization
Organization Name:UNION COUNTY SCHOOL DISTRICT #15
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-568-4424
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:COVE
Mailing Address - State:OR
Mailing Address - Zip Code:97824-0068
Mailing Address - Country:US
Mailing Address - Phone:541-568-4424
Mailing Address - Fax:541-568-4251
Practice Address - Street 1:803 MAIN ST.
Practice Address - Street 2:
Practice Address - City:COVE
Practice Address - State:OR
Practice Address - Zip Code:97824-0068
Practice Address - Country:US
Practice Address - Phone:541-568-4424
Practice Address - Fax:541-568-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005711Medicaid