Provider Demographics
NPI:1205015005
Name:SCHOOL DISTRICT OF PEWAUKEE
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF PEWAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAHAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:262-691-2100
Mailing Address - Street 1:404 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3630
Mailing Address - Country:US
Mailing Address - Phone:262-691-2100
Mailing Address - Fax:262-691-1052
Practice Address - Street 1:404 LAKE ST
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3630
Practice Address - Country:US
Practice Address - Phone:262-691-2100
Practice Address - Fax:262-691-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44210500Medicaid