Provider Demographics
NPI:1073792016
Name:TOMAH AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:TOMAH AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:FASBENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-374-7002
Mailing Address - Street 1:129 W CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-2507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:608-372-5087
Practice Address - Street 1:129 W CLIFTON ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-2507
Practice Address - Country:US
Practice Address - Phone:608-374-7011
Practice Address - Fax:608-372-5087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44217500Medicaid