Provider Demographics
NPI:1760491526
Name:OGDEN CITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:OGDEN CITY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, MEDICAID
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-737-7358
Mailing Address - Street 1:1950 MONROE BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-0619
Mailing Address - Country:US
Mailing Address - Phone:801-737-7358
Mailing Address - Fax:801-625-8972
Practice Address - Street 1:1950 MONROE BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-0619
Practice Address - Country:US
Practice Address - Phone:801-737-7358
Practice Address - Fax:801-625-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid