1508921248 NPI number — BUFFALO LAKE HECTOR ISD 2159

Table of content: (NPI 1508921248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508921248 NPI number — BUFFALO LAKE HECTOR ISD 2159

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUFFALO LAKE HECTOR ISD 2159
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:
1508921248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/28/2008
NPI Reactivation Date:
10/28/2010

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55314-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 W. 3RD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55314-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-833-5311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
RICK
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
320-833-5311

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  489723400 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 489723400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com