Provider Demographics
NPI:1487833133
Name:SCHOOL DISTRICT OF BELOIT
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF BELOIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR OF BUSINESS SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-361-4015
Mailing Address - Street 1:1633 KEELER AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-4713
Mailing Address - Country:US
Mailing Address - Phone:608-361-4015
Mailing Address - Fax:608-361-4123
Practice Address - Street 1:1633 KEELER AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-4713
Practice Address - Country:US
Practice Address - Phone:608-361-4015
Practice Address - Fax:608-361-4123
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 Licenses
StateLicense IDTaxonomies
WI44200300251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44200300Medicaid