Provider Demographics
NPI:1649459348
Name:CHEQUAMEGON SCHOOL DISTRICT
Entity type:Organization
Organization Name:CHEQUAMEGON SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:715-762-2474
Mailing Address - Street 1:420 9TH ST N
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552
Mailing Address - Country:US
Mailing Address - Phone:715-762-2474
Mailing Address - Fax:715-762-5469
Practice Address - Street 1:420 9TH ST N
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552
Practice Address - Country:US
Practice Address - Phone:715-762-2474
Practice Address - Fax:715-762-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44231000Medicaid