Provider Demographics
NPI:1720251218
Name:SCHOOL DISTRICT OF FORT ATKINSON
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF FORT ATKINSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-563-7807
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-2155
Mailing Address - Country:US
Mailing Address - Phone:920-563-7807
Mailing Address - Fax:920-563-7809
Practice Address - Street 1:201 PARK ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-2155
Practice Address - Country:US
Practice Address - Phone:920-563-7807
Practice Address - Fax:920-563-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44210100Medicaid