Provider Demographics
NPI:1609948728
Name:IND. SCHOOL DISTRICT #264
Entity type:Organization
Organization Name:IND. SCHOOL DISTRICT #264
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-677-2291
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:504 LOIS AVE N.
Mailing Address - City:HERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:56248-0288
Mailing Address - Country:US
Mailing Address - Phone:320-677-2291
Mailing Address - Fax:320-677-2412
Practice Address - Street 1:504 LOIS AVE N
Practice Address - Street 2:
Practice Address - City:HERMAN
Practice Address - State:MN
Practice Address - Zip Code:56248-0288
Practice Address - Country:US
Practice Address - Phone:320-677-2291
Practice Address - Fax:320-677-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN363633000Medicaid