Provider Demographics
NPI:1164591814
Name:PRIOR LAKE-SAVAGE INDEPENDENT SCHOOL DISTRICT #719
Entity Type:Organization
Organization Name:PRIOR LAKE-SAVAGE INDEPENDENT SCHOOL DISTRICT #719
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:STUDNICKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-492-8465
Mailing Address - Street 1:4540 TOWER ST SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2958
Mailing Address - Country:US
Mailing Address - Phone:952-226-0000
Mailing Address - Fax:
Practice Address - Street 1:4540 TOWER ST SE
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2958
Practice Address - Country:US
Practice Address - Phone:952-226-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)