Provider Demographics
NPI:1043374309
Name:INDEPENDENT SCHOOL DISTRICT #0458
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT #0458
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNKERMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-238-1472
Mailing Address - Street 1:401 E 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:TRUMAN
Mailing Address - State:MN
Mailing Address - Zip Code:56088-1322
Mailing Address - Country:US
Mailing Address - Phone:507-238-1472
Mailing Address - Fax:507-238-2361
Practice Address - Street 1:401 E 1ST ST S
Practice Address - Street 2:
Practice Address - City:TRUMAN
Practice Address - State:MN
Practice Address - Zip Code:56088-1322
Practice Address - Country:US
Practice Address - Phone:507-238-1472
Practice Address - Fax:507-238-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN946437900Medicaid
MN946437900Medicaid