Provider Demographics
NPI:1295890481
Name:INDEPENDENT SCHOOL DISTRICT 2759
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 2759
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TWITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-738-6442
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:EAGLE BEND
Mailing Address - State:MN
Mailing Address - Zip Code:56446-0299
Mailing Address - Country:US
Mailing Address - Phone:218-738-6442
Mailing Address - Fax:218-738-6493
Practice Address - Street 1:405 MAIN ST W
Practice Address - Street 2:
Practice Address - City:EAGLE BEND
Practice Address - State:MN
Practice Address - Zip Code:56446
Practice Address - Country:US
Practice Address - Phone:218-738-6442
Practice Address - Fax:218-738-6493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110180300Medicaid