1932397239 NPI number — SCHOOL DISTRICT NO 5

Table of content: (NPI 1932397239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932397239 NPI number — SCHOOL DISTRICT NO 5

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHOOL DISTRICT NO 5
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:
6
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:
1932397239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 278
Provider Second Line Business Mailing Address:
10 2ND AVE SW
Provider Business Mailing Address City Name:
PARK CITY
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59063-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-633-2361
Provider Business Mailing Address Fax Number:
406-633-2913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 2ND AVE. SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK CITY
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59063-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-633-2361
Provider Business Practice Location Address Fax Number:
406-633-2913
Provider Enumeration Date:
10/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AUDET
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
406-633-2406

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  0846 , 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: 0165070 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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