Provider Demographics
NPI:1255527594
Name:WILMOT SCHOOL DISTRICT 54-7
Entity type:Organization
Organization Name:WILMOT SCHOOL DISTRICT 54-7
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-938-4647
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:800 ORDWAY ST
Mailing Address - City:WILMOT
Mailing Address - State:SD
Mailing Address - Zip Code:57279-0100
Mailing Address - Country:US
Mailing Address - Phone:605-938-4647
Mailing Address - Fax:605-938-4185
Practice Address - Street 1:800 ORDWAY ST
Practice Address - Street 2:
Practice Address - City:WILMOT
Practice Address - State:SD
Practice Address - Zip Code:57279
Practice Address - Country:US
Practice Address - Phone:605-938-4647
Practice Address - Fax:605-938-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5150500Medicaid