Provider Demographics
NPI:1437124674
Name:WYOMISSING AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WYOMISSING AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:610-374-4031
Mailing Address - Street 1:630 EVANS AVE
Mailing Address - Street 2:DISTRICT OFFICE
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2636
Mailing Address - Country:US
Mailing Address - Phone:610-374-4031
Mailing Address - Fax:610-374-0498
Practice Address - Street 1:630 EVANS AVE
Practice Address - Street 2:DISTRICT OFFICE
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19610-2636
Practice Address - Country:US
Practice Address - Phone:610-374-4031
Practice Address - Fax:610-374-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011861980001Medicaid