Healthcare Provider Details

I. General information

NPI: 1265513089
Provider Name (Legal Business Name): INDEPENDENT SCHOOL DISTRICT NO 750
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 5TH AVE N
COLD SPRING MN
56320-1409
US

IV. Provider business mailing address

534 5TH AVE N
COLD SPRING MN
56320-1409
US

V. Phone/Fax

Practice location:
  • Phone: 320-685-4195
  • Fax: 320-685-4906
Mailing address:
  • Phone: 320-685-4195
  • Fax: 320-685-4906

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. SCOTT STASKA
Title or Position: SUPERINTENDENT
Credential:
Phone: 320-685-4195