Healthcare Provider Details

I. General information

NPI: 1790018257
Provider Name (Legal Business Name): CIRCLE USD 375
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MAIN STREET
TOWANDA KS
67144-0009
US

IV. Provider business mailing address

901 MAIN STREET
TOWANDA KS
67144-0009
US

V. Phone/Fax

Practice location:
  • Phone: 316-541-2577
  • Fax: 316-536-2499
Mailing address:
  • Phone: 316-541-2577
  • Fax: 316-536-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES B KELLER
Title or Position: SUPERINTENDENT
Credential:
Phone: 316-541-2577