Healthcare Provider Details

I. General information

NPI: 1750595369
Provider Name (Legal Business Name): DYSART UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PLACE
SURPRISE AZ
85374
US

IV. Provider business mailing address

15802 N PARKVIEW PLACE
SURPRISE AZ
85374
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. COLLEAN LUFKIN
Title or Position: ACCOUNTANT MEDCAID COORDINATOR
Credential:
Phone: 623-876-7114