Provider Demographics
NPI:1154482982
Name:SOUTHEAST POLK COMMUNITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SOUTHEAST POLK COMMUNITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-967-4294
Mailing Address - Street 1:8379 NE UNIVERSITY AVE.
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327
Mailing Address - Country:US
Mailing Address - Phone:515-967-4294
Mailing Address - Fax:
Practice Address - Street 1:8379 NE UNIVERSITY AVE.
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327
Practice Address - Country:US
Practice Address - Phone:515-967-4294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0265041Medicaid