1003960659 NPI number — COUNTY OF MADISON SCHOOL DISTRICT 321

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003960659 NPI number — COUNTY OF MADISON SCHOOL DISTRICT 321

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MADISON SCHOOL DISTRICT 321
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:
1003960659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 E CALDERWOOD DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83642-9097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-922-3093
Provider Business Mailing Address Fax Number:
208-922-9351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 N 1ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REXBURG
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83440-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-359-3315
Provider Business Practice Location Address Fax Number:
208-359-3370
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVESQUE
Authorized Official First Name:
TODD
Authorized Official Middle Name:
KENNETH
Authorized Official Title or Position:
SYSTEMS MANAGER
Authorized Official Telephone Number:
208-922-3093

Provider Taxonomy Codes

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

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

  • Identifier: 805146300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com