Provider Demographics
NPI:1780858076
Name:PALMYRA-EAGLE AREA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PALMYRA-EAGLE AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-495-7101
Mailing Address - Street 1:123 BURR OAK ST
Mailing Address - Street 2:PO BOX 901
Mailing Address - City:PALMYRA
Mailing Address - State:WI
Mailing Address - Zip Code:53156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 BURR OAK ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156
Practice Address - Country:US
Practice Address - Phone:262-495-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44203900Medicaid