Healthcare Provider Details

I. General information

NPI: 1124251368
Provider Name (Legal Business Name): USD 307
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E ANDERSON ST
BROOKVILLE KS
67425-9732
US

IV. Provider business mailing address

412 E ANDERSON ST
BROOKVILLE KS
67425-9732
US

V. Phone/Fax

Practice location:
  • Phone: 785-225-6813
  • Fax:
Mailing address:
  • Phone: 785-225-6813
  • 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: MR. JERRY MINNEMAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 785-225-6813