Provider Demographics
NPI:1457530255
Name:UNIFIED SCHOOL DISTRICT OF ANTIGO
Entity Type:Organization
Organization Name:UNIFIED SCHOOL DISTRICT OF ANTIGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:FILBRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-627-4355
Mailing Address - Street 1:120 S DORR ST
Mailing Address - Street 2:
Mailing Address - City:ANTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54409-1220
Mailing Address - Country:US
Mailing Address - Phone:715-627-4355
Mailing Address - Fax:715-623-3279
Practice Address - Street 1:120 S DORR ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-1220
Practice Address - Country:US
Practice Address - Phone:715-627-4355
Practice Address - Fax:715-623-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44210700Medicaid