=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417604471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENNINGTON PUBLIC SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2022
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11620 N 156TH ST
-----------------------------------------------------
City | BENNINGTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68007-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-238-3044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11620 N 156TH ST
-----------------------------------------------------
City | BENNINGTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68007-5401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-238-3044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF STUDENT SERVICES
-----------------------------------------------------
Name | DANIEL BOMBECK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 402-238-3044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------