Provider Demographics
NPI:1285330365
Name:FULLERTON PUBLIC SCHOOLS
Entity type:Organization
Organization Name:FULLERTON PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-550-0225
Mailing Address - Street 1:606 4TH ST # 520
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68638-3176
Mailing Address - Country:US
Mailing Address - Phone:308-536-2431
Mailing Address - Fax:308-536-2432
Practice Address - Street 1:606 4TH ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3176
Practice Address - Country:US
Practice Address - Phone:308-536-2431
Practice Address - Fax:308-536-2432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026722300Medicaid