Provider Demographics
NPI:1801991815
Name:ARTHUR COMMUNITY UNIT SCHOOL DISTRICT #305
Entity type:Organization
Organization Name:ARTHUR COMMUNITY UNIT SCHOOL DISTRICT #305
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-543-2511
Mailing Address - Street 1:301 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ARTHUR
Mailing Address - State:IL
Mailing Address - Zip Code:61911-1403
Mailing Address - Country:US
Mailing Address - Phone:217-543-2511
Mailing Address - Fax:217-543-2210
Practice Address - Street 1:301 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ARTHUR
Practice Address - State:IL
Practice Address - Zip Code:61911-1403
Practice Address - Country:US
Practice Address - Phone:217-543-2511
Practice Address - Fax:217-543-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
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