Provider Demographics
NPI:1790080836
Name:SEELEY LAKE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SEELEY LAKE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-677-2265
Mailing Address - Street 1:200 SCHOOL LANE
Mailing Address - Street 2:
Mailing Address - City:SEELEY LAKE
Mailing Address - State:MT
Mailing Address - Zip Code:59868-0840
Mailing Address - Country:US
Mailing Address - Phone:406-677-2265
Mailing Address - Fax:406-677-2264
Practice Address - Street 1:200 SCHOOL LANE
Practice Address - Street 2:
Practice Address - City:SEELEY LAKE
Practice Address - State:MT
Practice Address - Zip Code:59868-0840
Practice Address - Country:US
Practice Address - Phone:406-677-2265
Practice Address - Fax:406-677-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1477569473Medicaid