Provider Demographics
NPI:1033443965
Name:INGALLS SCHOOL
Entity Type:Organization
Organization Name:INGALLS SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOVACK
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:620-335-5136
Mailing Address - Street 1:P.O. BOX 99
Mailing Address - Street 2:100 BULLDOG DRIVE
Mailing Address - City:INGALLS
Mailing Address - State:KS
Mailing Address - Zip Code:67853
Mailing Address - Country:US
Mailing Address - Phone:620-335-5136
Mailing Address - Fax:620-335-5678
Practice Address - Street 1:100 BULLDOG DRIVE
Practice Address - Street 2:
Practice Address - City:INGALLS
Practice Address - State:KS
Practice Address - Zip Code:67853
Practice Address - Country:US
Practice Address - Phone:620-335-5136
Practice Address - Fax:620-335-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health