Provider Demographics
NPI:1144429119
Name:WEST BEND - MALLARD COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WEST BEND - MALLARD COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-887-7821
Mailing Address - Street 1:300 3RD AVE SW
Mailing Address - Street 2:PO BOX 247
Mailing Address - City:WEST BEND
Mailing Address - State:IA
Mailing Address - Zip Code:50597-8573
Mailing Address - Country:US
Mailing Address - Phone:515-887-7821
Mailing Address - Fax:515-887-7853
Practice Address - Street 1:300 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:IA
Practice Address - Zip Code:50597-8573
Practice Address - Country:US
Practice Address - Phone:515-887-7821
Practice Address - Fax:515-887-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6921#######Medicaid