Provider Demographics
NPI:1336314178
Name:SCHOOL DISTRICT OF NIAGARA
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF NIAGARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-251-1330
Mailing Address - Street 1:700 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA
Mailing Address - State:WI
Mailing Address - Zip Code:54151-1221
Mailing Address - Country:US
Mailing Address - Phone:715-251-1330
Mailing Address - Fax:
Practice Address - Street 1:700 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA
Practice Address - State:WI
Practice Address - Zip Code:54151-1221
Practice Address - Country:US
Practice Address - Phone:715-251-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44241000Medicaid