Healthcare Provider Details

I. General information

NPI: 1962274530
Provider Name (Legal Business Name): MALCOLM PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 NW 112TH ST
MALCOLM NE
68402-9561
US

IV. Provider business mailing address

10004 NW 112TH ST
MALCOLM NE
68402-9561
US

V. Phone/Fax

Practice location:
  • Phone: 402-796-2151
  • Fax:
Mailing address:
  • Phone: 402-796-2151
  • 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: JON SQUIER
Title or Position: DIRECTOR OF STUDENT SERVICES
Credential:
Phone: 402-796-2151