Provider Demographics
NPI:1124126792
Name:INDEPENDENT SCHOOL DISTRICT 761
Entity type:Organization
Organization Name:INDEPENDENT SCHOOL DISTRICT 761
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-444-8605
Mailing Address - Street 1:515 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-2816
Mailing Address - Country:US
Mailing Address - Phone:507-444-8600
Mailing Address - Fax:504-444-8699
Practice Address - Street 1:515 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-2816
Practice Address - Country:US
Practice Address - Phone:507-444-8600
Practice Address - Fax:504-444-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN457485100251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN457485100Medicaid