Provider Demographics
NPI:1104041557
Name:KITTSON COUNTY INDEPENDENT SCHOOL DISTRICT #356
Entity Type:Organization
Organization Name:KITTSON COUNTY INDEPENDENT SCHOOL DISTRICT #356
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:COFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-762-5400
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MN
Mailing Address - Zip Code:56735-0217
Mailing Address - Country:US
Mailing Address - Phone:218-762-5400
Mailing Address - Fax:
Practice Address - Street 1:401 CENTRAL AVE. S.
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MN
Practice Address - Zip Code:56735-0217
Practice Address - Country:US
Practice Address - Phone:218-762-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN452440300Medicare ID - Type UnspecifiedMA PROVIDER NUMBER