Healthcare Provider Details

I. General information

NPI: 1801029152
Provider Name (Legal Business Name): USD 484 FREDONIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 6TH ST
FREDONIA KS
66736-1305
US

IV. Provider business mailing address

300 N 6TH ST
FREDONIA KS
66736-1305
US

V. Phone/Fax

Practice location:
  • Phone: 620-378-4177
  • Fax:
Mailing address:
  • Phone:
  • 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. JIM PORTER
Title or Position: SUPERINTENDENT
Credential:
Phone: 620-378-4177