Provider Demographics
NPI:1295890127
Name:INDEPENDENT SCHOOL DISTRICT NO 2365
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT NO 2365
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:507-834-6501
Mailing Address - Street 1:323 EAST 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:GIBBON
Mailing Address - State:MN
Mailing Address - Zip Code:55335
Mailing Address - Country:US
Mailing Address - Phone:507-834-6501
Mailing Address - Fax:507-834-6264
Practice Address - Street 1:323 EAST 11TH STREET
Practice Address - Street 2:
Practice Address - City:GIBBON
Practice Address - State:MN
Practice Address - Zip Code:55335
Practice Address - Country:US
Practice Address - Phone:507-834-6501
Practice Address - Fax:507-834-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN758719800Medicaid