Provider Demographics
NPI:1386716363
Name:STEVENS COUNTY IND SCHOOL DIST 768
Entity type:Organization
Organization Name:STEVENS COUNTY IND SCHOOL DIST 768
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-392-5621
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:371 HANCOCK AVE
Mailing Address - City:HANCOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56244-0367
Mailing Address - Country:US
Mailing Address - Phone:320-392-5621
Mailing Address - Fax:320-392-5156
Practice Address - Street 1:371 HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MN
Practice Address - Zip Code:56244-0367
Practice Address - Country:US
Practice Address - Phone:320-392-5621
Practice Address - Fax:320-392-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN210620500Medicaid