=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053644096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REPUBLIC COUNTY UNIFIED SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2009
-----------------------------------------------------
Last Update Date | 09/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 19TH ST
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66935-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-527-5621
-----------------------------------------------------
Fax | 785-527-5675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 19TH ST
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66935-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-527-5621
-----------------------------------------------------
Fax | 785-527-5375
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | MR. TROY DAMMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 785-527-5621
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347B00000X
-----------------------------------------------------
Taxonomy Name | Bus
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------