Provider Demographics
NPI:1427191535
Name:IND SCHOOL DISTRICT 578
Entity Type:Organization
Organization Name:IND SCHOOL DISTRICT 578
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-629-4020
Mailing Address - Street 1:1400 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-2155
Mailing Address - Country:US
Mailing Address - Phone:320-629-4010
Mailing Address - Fax:320-629-4070
Practice Address - Street 1:1400 MAIN ST S
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-2155
Practice Address - Country:US
Practice Address - Phone:320-629-4010
Practice Address - Fax:320-629-4070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN954218300Medicaid