Healthcare Provider Details

I. General information

NPI: 1891028270
Provider Name (Legal Business Name): LA CROSSE USD 395
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 MAIN ST. BOX 778
LA CROSSE KS
67548-0778
US

IV. Provider business mailing address

616 MAIN ST. BOX 778
LA CROSSE KS
67548-0778
US

V. Phone/Fax

Practice location:
  • Phone: 785-222-2505
  • Fax: 785-222-3240
Mailing address:
  • Phone: 785-222-2505
  • Fax: 785-222-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateKS

VIII. Authorized Official

Name: BILL KEELEY
Title or Position: SUPERINTENDENT
Credential:
Phone: 785-222-2505