Provider Demographics
NPI:1881842573
Name:BEAVER DAM UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BEAVER DAM UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:SARNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-885-7300
Mailing Address - Street 1:705 MCKINLEY ST
Mailing Address - Street 2:BDUSD ESC
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1941
Mailing Address - Country:US
Mailing Address - Phone:920-885-7300
Mailing Address - Fax:920-885-7306
Practice Address - Street 1:705 MCKINLEY ST
Practice Address - Street 2:BDUSD ESC
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-1941
Practice Address - Country:US
Practice Address - Phone:920-885-7300
Practice Address - Fax:920-885-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44207900Medicaid