Provider Demographics
NPI:1104005685
Name:JOINT SCHOOL DISTRICT NO 2 CO CITY & TOWN OF BRILLION
Entity Type:Organization
Organization Name:JOINT SCHOOL DISTRICT NO 2 CO CITY & TOWN OF BRILLION
Other - Org Name:BRILLION PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-756-2368
Mailing Address - Street 1:315 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110-1294
Mailing Address - Country:US
Mailing Address - Phone:920-756-2368
Mailing Address - Fax:920-756-3705
Practice Address - Street 1:315 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1294
Practice Address - Country:US
Practice Address - Phone:920-756-2368
Practice Address - Fax:920-756-3705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44206300Medicaid