Provider Demographics
NPI:1376604793
Name:INDEPENDENT SCHOOL DISTRICT 625
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 625
Other - Org Name:SAINT PAUL PUBLIC SCHOOLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-767-8260
Mailing Address - Street 1:360 COLBORNE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3228
Mailing Address - Country:US
Mailing Address - Phone:651-767-8189
Mailing Address - Fax:
Practice Address - Street 1:360 COLBORNE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3228
Practice Address - Country:US
Practice Address - Phone:651-767-8189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN457315300Medicaid
MN123455200Medicaid