Provider Demographics
NPI:1508921248
Name:BUFFALO LAKE HECTOR ISD 2159
Entity Type:Organization
Organization Name:BUFFALO LAKE HECTOR ISD 2159
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-833-5311
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:BUFFALO LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55314-0278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 W. 3RD ST.
Practice Address - Street 2:
Practice Address - City:BUFFALO LAKE
Practice Address - State:MN
Practice Address - Zip Code:55314-0278
Practice Address - Country:US
Practice Address - Phone:320-833-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2010-10-28
Deactivation Date:2008-07-28
Deactivation Code:
Reactivation Date:2010-10-28
Provider Licenses
StateLicense IDTaxonomies
MN489723400251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN489723400Medicaid