MEDICARE: IND SCHOOL DISTRICT 630

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	:	1578643318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IND SCHOOL DISTRICT 630

Provider Business Mailing Address
First Line	:	PO BOX 399
Second Line	:
City	:	RED LAKE FALLS
State	:	MN
Zip	:	56750-0399
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 CHAMPAGNE AVE SW
Second Line	:
City	:	RED LAKE FALLS
State	:	MN
Zip	:	56750-0399
Country	:	US
Telephone Number	:	218-253-2139
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	JOEL YOUNG
Credential	:
Telephone Number	:	218-253-2139

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/16/2008

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