Healthcare Provider Details

I. General information

NPI: 1457685240
Provider Name (Legal Business Name): UNIFIED SCHOOL DISTRICT NO 264
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S PROSPECT ST
CLEARWATER KS
67026-2601
US

IV. Provider business mailing address

150 S PROSPECT ST PO BOX 248
CLEARWATER KS
67026-2601
US

V. Phone/Fax

Practice location:
  • Phone: 620-584-2091
  • Fax: 620-584-6705
Mailing address:
  • Phone: 620-584-2091
  • Fax: 620-584-6705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MIKE ROTH
Title or Position: SUPERINTENDENT
Credential:
Phone: 620-584-2091