MEDICARE: INDEPENDENT SCHOOL DISTRICT 640

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	:	1598820656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT SCHOOL DISTRICT 640

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:	1333 MAY ST
City	:	WABASSO
State	:	MN
Zip	:	56293-0069
Country	:	US
Telephone Number	:	507-342-5114
Fax Number	:	507-342-5203

Provider Business Practice Location Address
First Line	:	1333 MAY STREET
Second Line	:
City	:	WABASSO
State	:	MN
Zip	:	56293
Country	:	US
Telephone Number	:	507-342-5114
Fax Number	:	507-342-5203

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. TED L. SUSS
Credential	:
Telephone Number	:	507-342-5114

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	12/18/2008

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