Provider Demographics
NPI:1053520304
Name:NORRIS CITY-OMAHA-ENFIELD CSUD 3
Entity type:Organization
Organization Name:NORRIS CITY-OMAHA-ENFIELD CSUD 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-378-3222
Mailing Address - Street 1:409 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NORRIS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62869-1069
Mailing Address - Country:US
Mailing Address - Phone:618-378-3222
Mailing Address - Fax:618-378-3286
Practice Address - Street 1:409 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869-1069
Practice Address - Country:US
Practice Address - Phone:618-378-3222
Practice Address - Fax:618-378-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
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
IL=========002Medicaid