Provider Demographics
NPI:1235168030
Name:BRIDGEPORT SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BRIDGEPORT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:MA AD TO DOCTORAL
Authorized Official - Phone:509-686-5656
Mailing Address - Street 1:1300 TACOMA AVE
Mailing Address - Street 2:PO BOX 1060
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98813
Mailing Address - Country:US
Mailing Address - Phone:509-686-2201
Mailing Address - Fax:509-686-4052
Practice Address - Street 1:1300 TACOMA AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WA
Practice Address - Zip Code:98813
Practice Address - Country:US
Practice Address - Phone:509-686-2201
Practice Address - Fax:509-686-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7442379Medicaid