Provider Demographics
NPI:1225193618
Name:YELLOW MEDICINE EAST DISTRICT 2190
Entity Type:Organization
Organization Name:YELLOW MEDICINE EAST DISTRICT 2190
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-564-4081
Mailing Address - Street 1:450 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56241-1326
Mailing Address - Country:US
Mailing Address - Phone:320-564-4081
Mailing Address - Fax:320-564-4781
Practice Address - Street 1:450 9TH AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56241-1326
Practice Address - Country:US
Practice Address - Phone:320-564-4081
Practice Address - Fax:320-564-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN738324000Medicaid