Provider Demographics
NPI:1508050063
Name:BOULDER SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BOULDER SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-225-3740
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:MT
Mailing Address - Zip Code:59632-0838
Mailing Address - Country:US
Mailing Address - Phone:406-225-3740
Mailing Address - Fax:406-225-3289
Practice Address - Street 1:209 S WASHINGTON
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:MT
Practice Address - Zip Code:59632-0838
Practice Address - Country:US
Practice Address - Phone:406-225-3740
Practice Address - Fax:406-225-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0165997Medicaid
MT0166504Medicaid