MEDICARE: FORT BRAGG UNIFIED

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)		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497879274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT BRAGG UNIFIED

Provider Business Mailing Address
First Line	:	312 S LINCOLN ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4416
Country	:	US
Telephone Number	:	707-961-3503
Fax Number	:	707-964-5002

Provider Business Practice Location Address
First Line	:	312 S LINCOLN ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4416
Country	:	US
Telephone Number	:	707-961-3503
Fax Number	:	707-964-5002

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. STEVEN LUND
Credential	:
Telephone Number	:	707-961-2850

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	02/10/2009

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Directions to “FORT BRAGG UNIFIED ” Practice Location

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