Basic Information
| Provider Information | |||||||||
| NPI: | 1447391636 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIFIED SCHOOL DIST NO 353 | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WELLINGTON PUBLIC SCHOOLS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 SOUTH WASHINGTON | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671523037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203264300 | ||||||||
| FaxNumber: | 6203264304 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 SOUTH WASHINGTON | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671523037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6203264300 | ||||||||
| FaxNumber: | 6203264304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 08/21/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAID CLERK/MIS | ||||||||
| AuthorizedOfficialTelephone: | 6203264300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | KS | Y | Agencies | Local Education Agency (LEA) |
ID Information
| ID | Type | State | Issuer | Description | 052556974 | 01 | KS | TAX ID | OTHER | 100324270A | 05 | KS | MEDICAID |