Provider Demographics
NPI:1932206208
Name:INDEPENDENT SCHOOL DISTRICT 1
Entity Type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 1
Other - Org Name:AITKIN PUBLIC SCHOOLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THIRD PARTY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-454-5532
Mailing Address - Street 1:804 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401
Mailing Address - Country:US
Mailing Address - Phone:218-454-5532
Mailing Address - Fax:218-828-2148
Practice Address - Street 1:306 2ND ST NW
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1246
Practice Address - Country:US
Practice Address - Phone:218-927-2115
Practice Address - Fax:218-927-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-11-12
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-06-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN482494600Medicaid