MEDICARE: INDEPENDENT SCHOOL DISTRICT 16 ANOKA COUNTY

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	:	1588756290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT SCHOOL DISTRICT 16 ANOKA COUNTY

Provider Business Mailing Address
First Line	:	8000 HIGHWAY 65 NE
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2051
Country	:	US
Telephone Number	:	763-786-5570
Fax Number	:	763-784-7838

Provider Business Practice Location Address
First Line	:	1415 81ST AVE NE
Second Line	:
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2051
Country	:	US
Telephone Number	:	763-786-5570
Fax Number	:	763-784-7838

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL EDUCATION
Name	:	MR. THOMAS PAUL AMBRASAS
Credential	:
Telephone Number	:	763-785-5522

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/02/2008

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