Healthcare Provider Details

I. General information

NPI: 1144472655
Provider Name (Legal Business Name): SCHOOL DISTRICT OF COLBY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W SPENCE ST
COLBY WI
54421-9644
US

IV. Provider business mailing address

505 W SPENCE ST PO BOX 139
COLBY WI
54421-9644
US

V. Phone/Fax

Practice location:
  • Phone: 715-223-2301
  • Fax: 715-223-4539
Mailing address:
  • Phone: 715-223-2301
  • Fax: 715-223-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number1162
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1162
License Number StateWI

VIII. Authorized Official

Name: MR. J TERRY DOWNEN
Title or Position: SUPT.
Credential:
Phone: 715-223-2301