MEDICARE: HUSTISFORD 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
1	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366633430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUSTISFORD SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	845 S LAKE ST
Second Line	:
City	:	HUSTISFORD
State	:	WI
Zip	:	53034-9790
Country	:	US
Telephone Number	:	920-349-8109
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 S LAKE ST
Second Line	:
City	:	HUSTISFORD
State	:	WI
Zip	:	53034-9790
Country	:	US
Telephone Number	:	920-349-8109
Fax Number	:

Authorized Official
Title or Position	:	DISTRICT ADMINISTRATOR
Name	:	MR. ED VAN RAVENSTEIN
Credential	:
Telephone Number	:	920-349-8109

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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Directions to “HUSTISFORD SCHOOL DISTRICT ” Practice Location

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