MEDICARE: IND SCHOOL DIST 391

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	502405600	OTHER	MN	MN HEALTH CARE PROGRAM

General Provider Information

NPI Number	:	1871655175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IND SCHOOL DIST 391

Provider Business Mailing Address
First Line	:	400 6TH ST
Second Line	:	BOX 310
City	:	CLEVELAND
State	:	MN
Zip	:	56017
Country	:	US
Telephone Number	:	507-931-5953
Fax Number	:	507-931-9088

Provider Business Practice Location Address
First Line	:	400 6TH ST
Second Line	:	BOX 310
City	:	CLEVELAND
State	:	MN
Zip	:	56017
Country	:	US
Telephone Number	:	507-931-5953
Fax Number	:	507-931-9088

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	BRIAN J. PHILLIPS
Credential	:
Telephone Number	:	507-931-5953

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	06/16/2008

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Directions to “IND SCHOOL DIST 391 ” Practice Location

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