Provider Demographics
NPI:1437378320
Name:ST. MARIES SCHOOL DISTRICT #41
Entity Type:Organization
Organization Name:ST. MARIES SCHOOL DISTRICT #41
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLING
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-245-2142
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:ST MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-0384
Mailing Address - Country:US
Mailing Address - Phone:208-245-2142
Mailing Address - Fax:208-245-5650
Practice Address - Street 1:720 MAIN AVE
Practice Address - Street 2:
Practice Address - City:ST MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1849
Practice Address - Country:US
Practice Address - Phone:208-245-2142
Practice Address - Fax:208-245-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0028167Medicaid