Provider Demographics
NPI:1871624338
Name:SUMMERSVILLE SD 79
Entity type:Organization
Organization Name:SUMMERSVILLE SD 79
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-244-8079
Mailing Address - Street 1:1118 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-5726
Mailing Address - Country:US
Mailing Address - Phone:618-244-8079
Mailing Address - Fax:
Practice Address - Street 1:1118 FAIRFIELD RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-5726
Practice Address - Country:US
Practice Address - Phone:618-244-8079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
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=========001Medicaid