Provider Demographics
NPI:1093845778
Name:ROUTT COUNTY SCHOOL DIST RE 3
Entity Type:Organization
Organization Name:ROUTT COUNTY SCHOOL DIST RE 3
Other - Org Name:SOUTH ROUTT SCHOOL DIST RE3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-736-2313
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:80467-0158
Mailing Address - Country:US
Mailing Address - Phone:970-736-2313
Mailing Address - Fax:
Practice Address - Street 1:305 S GRANT ST
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:CO
Practice Address - Zip Code:80467
Practice Address - Country:US
Practice Address - Phone:970-736-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87271541Medicaid