Provider Demographics
NPI:1194918938
Name:COLFAX-MINGO COMMUNITY SCHOOL DISTRICT
Entity type:Organization
Organization Name:COLFAX-MINGO COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DEMARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-521-1870
Mailing Address - Street 1:1000 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:IA
Mailing Address - Zip Code:50054-9619
Mailing Address - Country:US
Mailing Address - Phone:515-674-4111
Mailing Address - Fax:515-674-4940
Practice Address - Street 1:1000 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:IA
Practice Address - Zip Code:50054-9619
Practice Address - Country:US
Practice Address - Phone:515-674-4111
Practice Address - Fax:515-674-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0400255Medicaid