Provider Demographics
NPI:1659547016
Name:BENTON SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BENTON SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-759-4002
Mailing Address - Street 1:41 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:WI
Mailing Address - Zip Code:53803-8908
Mailing Address - Country:US
Mailing Address - Phone:608-759-4002
Mailing Address - Fax:608-759-3805
Practice Address - Street 1:41 ALMA ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:WI
Practice Address - Zip Code:53803-8908
Practice Address - Country:US
Practice Address - Phone:608-759-4002
Practice Address - Fax:608-759-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44234200Medicaid