Provider Demographics
NPI:1386942563
Name:MEXICO CENTRAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:MEXICO CENTRAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-963-8400
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:4320 STATE ROUTE 104
Mailing Address - City:NEW HAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:13121-0119
Mailing Address - Country:US
Mailing Address - Phone:315-963-8400
Mailing Address - Fax:
Practice Address - Street 1:4320 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:NY
Practice Address - Zip Code:13121
Practice Address - Country:US
Practice Address - Phone:315-963-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01366949Medicaid