1528291911 NPI number — USD 332 CUNNINGHAM - WEST KINGMAN COUNTY

Table of content: (NPI 1528291911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528291911 NPI number — USD 332 CUNNINGHAM - WEST KINGMAN COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USD 332 CUNNINGHAM - WEST KINGMAN COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528291911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67
Provider Second Line Business Mailing Address:
117 N. MAIN STREET
Provider Business Mailing Address City Name:
CUNNINGHAM
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67035-0067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-298-3271
Provider Business Mailing Address Fax Number:
620-298-2562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUNNINGHAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67035-9737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-298-3271
Provider Business Practice Location Address Fax Number:
620-298-2562
Provider Enumeration Date:
09/01/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FORTMAYER
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
620-298-3271

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)