Provider Demographics
NPI:1164455283
Name:PROVO CITY BOARD OF EDUCATION
Entity Type:Organization
Organization Name:PROVO CITY BOARD OF EDUCATION
Other - Org Name:PROVO CITY SCHOOL DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:H
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-374-4934
Mailing Address - Street 1:280 W 940 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3326
Mailing Address - Country:US
Mailing Address - Phone:801-374-4851
Mailing Address - Fax:801-374-4808
Practice Address - Street 1:280 W 940 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3326
Practice Address - Country:US
Practice Address - Phone:801-374-4851
Practice Address - Fax:801-374-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========021Medicaid