Healthcare Provider Details

I. General information

NPI: 1790914190
Provider Name (Legal Business Name): SANTA FE TRAIL USD 434
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 E US HIGHWAY 56
CARBONDALE KS
66414-9178
US

IV. Provider business mailing address

1663 E US HIGHWAY 56
CARBONDALE KS
66414-9178
US

V. Phone/Fax

Practice location:
  • Phone: 785-665-7168
  • Fax:
Mailing address:
  • Phone: 785-665-7168
  • 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: DR. STEVE PEGRAM
Title or Position: SUPERINTENDENT
Credential:
Phone: 785-665-7168