Provider Demographics
NPI:1952580656
Name:MELLEN SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MELLEN SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-274-3601
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:MELLEN
Mailing Address - State:WI
Mailing Address - Zip Code:54546-0500
Mailing Address - Country:US
Mailing Address - Phone:715-271-3601
Mailing Address - Fax:715-274-3715
Practice Address - Street 1:420 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MELLEN
Practice Address - State:WI
Practice Address - Zip Code:54546-9045
Practice Address - Country:US
Practice Address - Phone:715-271-3601
Practice Address - Fax:715-274-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44230900Medicaid