=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588845630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST GREENE COMMUNITY SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2007
-----------------------------------------------------
Last Update Date | 11/16/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 12TH ST SOUTH
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-738-5741
-----------------------------------------------------
Fax | 515-738-5719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 377 405 12TH ST SOUTH
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-738-5741
-----------------------------------------------------
Fax | 515-738-5719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | MR. G MICHAEL HARTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 515-738-5741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------