Provider Demographics
NPI:1295901882
Name:PITTSVILLE PUBLIC SCHOOL
Entity type:Organization
Organization Name:PITTSVILLE PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-884-5221
Mailing Address - Street 1:5459 ELEMENTARY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PITTSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54466-9550
Mailing Address - Country:US
Mailing Address - Phone:715-884-6694
Mailing Address - Fax:715-884-5218
Practice Address - Street 1:5459 ELEMENTARY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54466-9550
Practice Address - Country:US
Practice Address - Phone:715-884-6694
Practice Address - Fax:715-884-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44208500Medicaid