Healthcare Provider Details

I. General information

NPI: 1427075282
Provider Name (Legal Business Name): CARROLL COMMUNITY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 N ADAMS ST
CARROLL IA
51401-1911
US

IV. Provider business mailing address

1026 N ADAMS ST
CARROLL IA
51401-1911
US

V. Phone/Fax

Practice location:
  • Phone: 712-792-8040
  • Fax: 712-792-8008
Mailing address:
  • Phone: 712-792-8040
  • Fax: 712-792-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GARY D BENGTSON
Title or Position: DIRECTOR OF BUSINESS AFFAIRS
Credential:
Phone: 712-792-8040