Healthcare Provider Details

I. General information

NPI: 1487988978
Provider Name (Legal Business Name): USD 209 MOSCOW PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W HIGH SCHOOL ROAD
MOSCOW KS
67952-0158
US

IV. Provider business mailing address

PO BOX 158
MOSCOW KS
67952-0158
US

V. Phone/Fax

Practice location:
  • Phone: 620-598-2205
  • Fax:
Mailing address:
  • Phone: 620-598-2205
  • 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: LARRY PHILIPPI
Title or Position: SUPERINTENDENT
Credential:
Phone: 620-598-2205