Healthcare Provider Details

I. General information

NPI: 1427380492
Provider Name (Legal Business Name): USD 333/LCNCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 VALLEY ST
CONCORDIA KS
66901-3621
US

IV. Provider business mailing address

217 W 7TH ST
CONCORDIA KS
66901-2803
US

V. Phone/Fax

Practice location:
  • Phone: 785-243-3294
  • Fax: 785-243-8822
Mailing address:
  • Phone: 785-243-3518
  • Fax: 785-243-8883

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: MS. BEVERLY MORTIMER
Title or Position: SUPERINTENDENT
Credential:
Phone: 785-243-3518