Provider Demographics
NPI:1932397239
Name:SCHOOL DISTRICT NO 5
Entity Type:Organization
Organization Name:SCHOOL DISTRICT NO 5
Other - Org Name:COUNTY OF STILLWATER/PARK CITY SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AUDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-633-2406
Mailing Address - Street 1:P.O. BOX 278
Mailing Address - Street 2:10 2ND AVE SW
Mailing Address - City:PARK CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59063-0278
Mailing Address - Country:US
Mailing Address - Phone:406-633-2361
Mailing Address - Fax:406-633-2913
Practice Address - Street 1:10 2ND AVE. SW
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:MT
Practice Address - Zip Code:59063-0278
Practice Address - Country:US
Practice Address - Phone:406-633-2361
Practice Address - Fax:406-633-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0846251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0165070Medicaid