1578787602 NPI number — SWEET GRASS COUNTY HIGH SCHOOL

Table of content: (NPI 1578787602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578787602 NPI number — SWEET GRASS COUNTY HIGH SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SWEET GRASS COUNTY HIGH SCHOOL
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:
1578787602
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 886
Provider Second Line Business Mailing Address:
501 WEST 5TH AVE.
Provider Business Mailing Address City Name:
BIG TIMBER
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59011-0886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-932-5993
Provider Business Mailing Address Fax Number:
406-932-5982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 WEST 5TH AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG TIMBER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59011-0886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-932-5993
Provider Business Practice Location Address Fax Number:
406-932-5982
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUERKLE
Authorized Official First Name:
ALVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
406-932-5993

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  0882 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0162656 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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