Healthcare Provider Details

I. General information

NPI: 1548315732
Provider Name (Legal Business Name): RUSSELL COUNTY USD 407
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 N MAIN ST
RUSSELL KS
67665-1966
US

IV. Provider business mailing address

802 N MAIN ST
RUSSELL KS
67665-1966
US

V. Phone/Fax

Practice location:
  • Phone: 785-483-3226
  • Fax: 785-483-2175
Mailing address:
  • Phone: 785-483-3226
  • Fax: 785-483-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateKS

VIII. Authorized Official

Name: MRS. KATHY E COOK
Title or Position: SPECIAL EDUCATION DIRECTOR
Credential: BS, MS, EDS
Phone: 785-483-3226