1275778870 NPI number — WHITE LAKE SCHOOL DISTRICT

Table of content: (NPI 1275778870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275778870 NPI number — WHITE LAKE SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE LAKE SCHOOL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275778870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 EAST DIVISION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE LAKE
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57383-0245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-249-2251
Provider Business Mailing Address Fax Number:
605-249-2725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 SOUTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57369-0228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-337-2636
Provider Business Practice Location Address Fax Number:
605-337-2271
Provider Enumeration Date:
12/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
BERLE
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
605-249-2251

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5150250 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".