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NPI Code Detail

MEDICARE: BULLHEAD CITY ELEMENTARY SCHOOL DISTRICT

MEDICARE: BULLHEAD CITY ELEMENTARY SCHOOL DISTRICT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program585713AZ

General Provider Information

NPI Number : 1275726689
Entity Type Code : Organization
Provider Name (Legal Business Name) : BULLHEAD CITY ELEMENTARY SCHOOL DISTRICT
Provider Business Mailing Address
First Line : 1004 HANCOCK ROAD
Second Line :
City : BULLHEAD CITY
State : AZ
Zip : 86442-5946
Country : US
Telephone Number : 928-758-3961
Fax Number : 928-758-4996
Provider Business Practice Location Address
First Line : 1004 HANCOCK ROAD
Second Line :
City : BULLHEAD CITY
State : AZ
Zip : 86442-5946
Country : US
Telephone Number : 928-758-3961
Fax Number : 928-758-4996
Authorized Official
Title or Position : BUSINESS MANAGER
Name : MR. BENJE DON HOOKSTRA
Credential :
Telephone Number : 928-758-3961
Provider Enumeration Date : 08/20/2007
Last Update Date : 07/30/2008

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Directions to “BULLHEAD CITY ELEMENTARY SCHOOL DISTRICT ” Practice Location

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