1770651754 NPI number — IND SCHOOL DIST 883

Table of content: (NPI 1770651754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770651754 NPI number — IND SCHOOL DIST 883

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IND SCHOOL DIST 883
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:
ISD #883 ROCKFORD
Provider Other Organization Name Type Code:
5
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:
1770651754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55373-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-477-9165
Provider Business Mailing Address Fax Number:
763-477-5833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6051 ASH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55373-0009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-477-9165
Provider Business Practice Location Address Fax Number:
763-477-5833
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
763-477-9165

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 215612100 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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