Healthcare Provider Details

I. General information

NPI: 1275730996
Provider Name (Legal Business Name): NORTHWESTERN AREA SCHOOL DISTRICT 56-7
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 3RD SCHOOL ST
MELLETTE SD
57461
US

IV. Provider business mailing address

221 3RD SCHOOL ST
MELLETTE SD
57461
US

V. Phone/Fax

Practice location:
  • Phone: 605-887-3467
  • Fax: 605-887-3101
Mailing address:
  • Phone: 605-887-3467
  • Fax: 605-887-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number5152070
License Number StateSD

VIII. Authorized Official

Name: LISA S FRERICKS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-887-3467