Provider Demographics
NPI:1104012376
Name:DEUEL SCHOOL DISTRICT 19-4
Entity Type:Organization
Organization Name:DEUEL SCHOOL DISTRICT 19-4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-874-2161
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57226-0770
Mailing Address - Country:US
Mailing Address - Phone:605-874-2161
Mailing Address - Fax:605-874-8585
Practice Address - Street 1:410 5TH STREET WEST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:SD
Practice Address - Zip Code:57226-0700
Practice Address - Country:US
Practice Address - Phone:605-874-2161
Practice Address - Fax:605-874-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD515-0350Medicaid