=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568830651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARK COUNTY SCHOOL DISTRICT RE2
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2015
-----------------------------------------------------
Last Update Date | 09/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 HATHAWAY ST.
-----------------------------------------------------
City | FAIRPLAY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80440-0189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-836-4407
-----------------------------------------------------
Fax | 719-836-2275
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 189
-----------------------------------------------------
City | FAIRPLAY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80440-0189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-836-4407
-----------------------------------------------------
Fax | 719-836-2275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | MRS. BECKY ANN MINNIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-836-4407
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------