Provider Demographics
NPI:1639358500
Name:WILMOT UNION HIGH SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WILMOT UNION HIGH SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-862-2351
Mailing Address - Street 1:11112 308TH AVE
Mailing Address - Street 2:P.O. BOX 8
Mailing Address - City:WILMOT
Mailing Address - State:WI
Mailing Address - Zip Code:53192
Mailing Address - Country:US
Mailing Address - Phone:262-862-2351
Mailing Address - Fax:262-862-6413
Practice Address - Street 1:11112 308TH AVE
Practice Address - Street 2:
Practice Address - City:WILMOT
Practice Address - State:WI
Practice Address - Zip Code:53192
Practice Address - Country:US
Practice Address - Phone:262-862-2351
Practice Address - Fax:262-862-6413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44204600Medicaid