MEDICARE: INDEPENDENT SCHOOL DISTRICT 0877

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1518035278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT SCHOOL DISTRICT 0877

Provider Business Mailing Address
First Line	:	214 1ST AVE NE
Second Line	:	BUFFALO
City	:	BUFFALO
State	:	MN
Zip	:	55313-1602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 1ST AVE NE
Second Line	:	BUFFALO
City	:	BUFFALO
State	:	MN
Zip	:	55313-1602
Country	:	US
Telephone Number	:	763-682-5200
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL EDUCATION
Name	:	JUDY COLEY
Credential	:
Telephone Number	:	763-682-8721

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/22/2020

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