Provider Demographics
NPI:1053404541
Name:MSD OF WARREN COUNTY
Entity type:Organization
Organization Name:MSD OF WARREN COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-762-3364
Mailing Address - Street 1:101 N MONROE STREET
Mailing Address - Street 2:PO BOX 207
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47993
Mailing Address - Country:US
Mailing Address - Phone:765-762-3364
Mailing Address - Fax:765-762-6623
Practice Address - Street 1:101 N MONROE STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:IN
Practice Address - Zip Code:47993
Practice Address - Country:US
Practice Address - Phone:765-762-3364
Practice Address - Fax:765-762-6623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100197450Medicaid