Provider Demographics
NPI:1376722066
Name:SCHOOL DISTRICT OF MARION
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF MARION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:GUS
Authorized Official - Last Name:KNITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-754-2511
Mailing Address - Street 1:1001 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:WI
Mailing Address - Zip Code:54950-8703
Mailing Address - Country:US
Mailing Address - Phone:715-754-4501
Mailing Address - Fax:715-754-4508
Practice Address - Street 1:1001 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:WI
Practice Address - Zip Code:54950-8703
Practice Address - Country:US
Practice Address - Phone:715-754-4501
Practice Address - Fax:715-754-4508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44213000Medicaid