Provider Demographics
NPI:1366620379
Name:POPE COUNTY CUSD #1
Entity type:Organization
Organization Name:POPE COUNTY CUSD #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UNIT SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-683-2301
Mailing Address - Street 1:RT. 2 BOX 22
Mailing Address - Street 2:
Mailing Address - City:GOLCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:62938
Mailing Address - Country:US
Mailing Address - Phone:618-683-2301
Mailing Address - Fax:618-683-5181
Practice Address - Street 1:RR 2 BOX 22
Practice Address - Street 2:
Practice Address - City:GOLCONDA
Practice Address - State:IL
Practice Address - Zip Code:62938-9503
Practice Address - Country:US
Practice Address - Phone:618-683-2301
Practice Address - Fax:618-683-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid