Provider Demographics
NPI:1578787602
Name:SWEET GRASS COUNTY HIGH SCHOOL
Entity Type:Organization
Organization Name:SWEET GRASS COUNTY HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUERKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-932-5993
Mailing Address - Street 1:PO BOX 886
Mailing Address - Street 2:501 WEST 5TH AVE.
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011-0886
Mailing Address - Country:US
Mailing Address - Phone:406-932-5993
Mailing Address - Fax:406-932-5982
Practice Address - Street 1:501 WEST 5TH AVE.
Practice Address - Street 2:
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011-0886
Practice Address - Country:US
Practice Address - Phone:406-932-5993
Practice Address - Fax:406-932-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0882251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0162656Medicaid