MEDICARE: PRIOR LAKE-SAVAGE INDEPENDENT SCHOOL DISTRICT #719

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	:	1164591814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIOR LAKE-SAVAGE INDEPENDENT SCHOOL DISTRICT #719

Provider Business Mailing Address
First Line	:	4540 TOWER ST SE
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2958
Country	:	US
Telephone Number	:	952-226-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 TOWER ST SE
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2958
Country	:	US
Telephone Number	:	952-226-0000
Fax Number	:

Authorized Official
Title or Position	:	THIRD PARTY BILLING
Name	:	MRS. MONICA MARY STUDNICKA
Credential	:
Telephone Number	:	952-492-8465

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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