Provider Demographics
NPI:1477611929
Name:INDEPENDENT SCHOOL DISTRICT 207 OF BRANDON
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 207 OF BRANDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-834-4084
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MN
Mailing Address - Zip Code:56315-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 AGA DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1796
Practice Address - Country:US
Practice Address - Phone:320-762-2141
Practice Address - Fax:320-762-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
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
MN510698200Medicaid