Provider Demographics
NPI:1932533890
Name:NORTH GEM SCHOOL DISTRICT #149
Entity Type:Organization
Organization Name:NORTH GEM SCHOOL DISTRICT #149
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-604-1557
Mailing Address - Street 1:360 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:ID
Mailing Address - Zip Code:83217-0000
Mailing Address - Country:US
Mailing Address - Phone:208-648-7848
Mailing Address - Fax:208-648-7895
Practice Address - Street 1:360 SOUTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BANCROFT
Practice Address - State:ID
Practice Address - Zip Code:83217-0000
Practice Address - Country:US
Practice Address - Phone:208-648-7848
Practice Address - Fax:208-648-7895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========Medicaid