Provider Demographics
NPI:1225363120
Name:USD 102 CIMARRON-ENSIGN
Entity Type:Organization
Organization Name:USD 102 CIMARRON-ENSIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL ED. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-657-6023
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0489
Mailing Address - Country:US
Mailing Address - Phone:620-855-7743
Mailing Address - Fax:620-855-7745
Practice Address - Street 1:314 NORTH 1ST STREET
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835
Practice Address - Country:US
Practice Address - Phone:620-855-7743
Practice Address - Fax:620-855-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health