Provider Demographics
NPI:1760928477
Name:MSD OF BOONE TOWNSHIP
Entity Type:Organization
Organization Name:MSD OF BOONE TOWNSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KLEEFISCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-996-4771
Mailing Address - Street 1:307 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341-8909
Mailing Address - Country:US
Mailing Address - Phone:219-996-4771
Mailing Address - Fax:219-996-4771
Practice Address - Street 1:307 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341-8909
Practice Address - Country:US
Practice Address - Phone:219-996-4771
Practice Address - Fax:219-996-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)