Healthcare Provider Details

I. General information

NPI: 1497806145
Provider Name (Legal Business Name): LAWTON-BRONSON COMMUNITY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TARA WAY
LAWTON IA
51030-0128
US

IV. Provider business mailing address

100 TARA WAY
LAWTON IA
51030-0128
US

V. Phone/Fax

Practice location:
  • Phone: 712-944-5181
  • Fax: 712-944-5568
Mailing address:
  • Phone: 712-944-5181
  • Fax: 712-944-5568

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: BONITA GRIGG
Title or Position: SCHOOL NURSE MEDICAID CLAIMS COORDI
Credential:
Phone: 712-944-5181