Provider Demographics
NPI:1497838213
Name:STEARNS & MEEKER COS IND SCHOOL DIST 739
Entity Type:Organization
Organization Name:STEARNS & MEEKER COS IND SCHOOL DIST 739
Other - Org Name:IND SCHOOL DIST 739
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-398-5585
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MN
Mailing Address - Zip Code:55353-0368
Mailing Address - Country:US
Mailing Address - Phone:320-398-5585
Mailing Address - Fax:320-398-7733
Practice Address - Street 1:100 W EST HWY 55
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MN
Practice Address - Zip Code:55353
Practice Address - Country:US
Practice Address - Phone:320-398-5585
Practice Address - Fax:320-398-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
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
MN153407600Medicaid