Healthcare Provider Details

I. General information

NPI: 1922576453
Provider Name (Legal Business Name): LIMA SCHOOL DISTRICT #12
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N. HARRISON STREET
LIMA MT
59739
US

IV. Provider business mailing address

PO BOX 186
LIMA MT
59739-0186
US

V. Phone/Fax

Practice location:
  • Phone: 406-276-3571
  • Fax: 406-276-3495
Mailing address:
  • Phone: 406-276-3571
  • Fax: 406-276-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. BRIAN RAYBURN
Title or Position: SUPERINTENDENT
Credential: MED, CAGS
Phone: 406-276-3571