MEDICARE: BULTUM ACADEMY CHARTER SCHOOL

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	:	1396568952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BULTUM ACADEMY CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	1555 40TH AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 40TH AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3103
Country	:	US
Telephone Number	:	763-450-3522
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ARIF BAKAR
Credential	:
Telephone Number	:	763-568-4659

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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