Provider Demographics
NPI:1972652295
Name:MFL MARMAC CSD
Entity Type:Organization
Organization Name:MFL MARMAC CSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-539-4795
Mailing Address - Street 1:700 SOUTH PAGE STREET
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:IA
Mailing Address - Zip Code:52159-0544
Mailing Address - Country:US
Mailing Address - Phone:563-539-4795
Mailing Address - Fax:563-539-4913
Practice Address - Street 1:700 SOUTH PAGE STREET
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:IA
Practice Address - Zip Code:52159-0544
Practice Address - Country:US
Practice Address - Phone:563-539-4795
Practice Address - Fax:563-539-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0484022Medicaid