1447270657 NPI number — CLAY CENTER USD 379

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447270657 NPI number — CLAY CENTER USD 379

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY CENTER USD 379
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:
1447270657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIRARD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66743-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-654-8701
Provider Business Mailing Address Fax Number:
620-724-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 DEXTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAY CENTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67432-2636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-632-3178
Provider Business Practice Location Address Fax Number:
785-632-5020
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOEHLER
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
SPECIAL EDUCATION DIRECTOR
Authorized Official Telephone Number:
785-632-3178

Provider Taxonomy Codes

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

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

  • Identifier: 100263160A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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