MEDICARE: IND SCHOOL DIST 2889

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1093892754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IND SCHOOL DIST 2889

Provider Business Mailing Address
First Line	:	PO BOX 209
Second Line	:
City	:	AUDUBON
State	:	MN
Zip	:	56511
Country	:	US
Telephone Number	:	218-439-6876
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 LAKE STREET
Second Line	:
City	:	LAKE PARK
State	:	MN
Zip	:	56554
Country	:	US
Telephone Number	:	218-238-5914
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL EDUCATION DIRECTOR
Name	:	NORMA ALTMANN BERGSETH
Credential	:
Telephone Number	:	218-439-6876

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/18/2008

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