Provider Demographics
NPI:1871630798
Name:AJO UNIFIED SCHOOL DISTRICT #15
Entity type:Organization
Organization Name:AJO UNIFIED SCHOOL DISTRICT #15
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:CLAUDIAN
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-387-5619
Mailing Address - Street 1:111 N WELL RD
Mailing Address - Street 2:P.O. BOX 68
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321-1840
Mailing Address - Country:US
Mailing Address - Phone:520-387-5618
Mailing Address - Fax:520-387-6545
Practice Address - Street 1:111 N WELL RD
Practice Address - Street 2:
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321-1840
Practice Address - Country:US
Practice Address - Phone:520-387-5618
Practice Address - Fax:520-387-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ868838Medicaid