1891974762 NPI number — SALMON RIVER SCHOOL DISTRICT 243

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 1891974762 NPI number — SALMON RIVER SCHOOL DISTRICT 243

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SALMON RIVER SCHOOL DISTRICT 243
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:
1891974762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 E FAIRVIEW AVE STE 201
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:
83642-1733
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:
711 ACES PLACE
Provider Second Line Business Practice Location Address:
SALMON RIVER HIGH SCHOOL
Provider Business Practice Location Address City Name:
RIGGINS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-628-3431
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2007

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)





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