Provider Demographics
NPI:1679760052
Name:WAVERLY SCHOOL DISTRICT 14 5
Entity Type:Organization
Organization Name:WAVERLY SCHOOL DISTRICT 14 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HEMMINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-886-9174
Mailing Address - Street 1:319 MARY PLACE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9700
Mailing Address - Country:US
Mailing Address - Phone:605-886-9174
Mailing Address - Fax:605-886-6630
Practice Address - Street 1:319 MARY PLACE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:SD
Practice Address - Zip Code:57201-9700
Practice Address - Country:US
Practice Address - Phone:605-886-9174
Practice Address - Fax:605-886-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5150470Medicaid