Healthcare Provider Details

I. General information

NPI: 1497835227
Provider Name (Legal Business Name): FERTILE-BELTRAMI PUBLIC SCHOOLS IND SCHOOL DIST 599
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MILL STREET S
FERTILE MN
56540-0648
US

IV. Provider business mailing address

PO BOX 648
FERTILE MN
56540-0648
US

V. Phone/Fax

Practice location:
  • Phone: 218-945-6933
  • Fax:
Mailing address:
  • Phone:
  • 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: BRIAN CLARKE
Title or Position: SUPERINTENDENT
Credential:
Phone: 218-945-6933