Provider Demographics
NPI:1821194044
Name:CANBY PUBLIC SCHOOLS ISD 891
Entity Type:Organization
Organization Name:CANBY PUBLIC SCHOOLS ISD 891
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:3RD PARTY BILLING ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-269-9243
Mailing Address - Street 1:306 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-1406
Mailing Address - Country:US
Mailing Address - Phone:320-269-9243
Mailing Address - Fax:320-269-7132
Practice Address - Street 1:307 1ST ST W
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:MN
Practice Address - Zip Code:56220-1411
Practice Address - Country:US
Practice Address - Phone:507-223-5965
Practice Address - Fax:507-223-7536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN601523900Medicaid