Provider Demographics
NPI:1770652489
Name:INGHAM INTERMEDIATE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:INGHAM INTERMEDIATE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOGUT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:517-676-1051
Mailing Address - Street 1:2630 W HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9329
Mailing Address - Country:US
Mailing Address - Phone:517-676-1051
Mailing Address - Fax:517-676-1277
Practice Address - Street 1:2630 W HOWELL RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9329
Practice Address - Country:US
Practice Address - Phone:517-676-1051
Practice Address - Fax:517-676-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
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
MI2958985Medicaid