MEDICARE: YELLOWSTONE ACADEMY SCHOOL

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)	LEA1196	MT

General Provider Information

NPI Number	:	1891045548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YELLOWSTONE ACADEMY SCHOOL

Provider Business Mailing Address
First Line	:	1750 RAY OF HOPE LN
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59106-3502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 RAY OF HOPE LN
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59106-3502
Country	:	US
Telephone Number	:	406-656-2198
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. MIKE SULLIVAN
Credential	:
Telephone Number	:	406-656-2198

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	09/10/2012

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Directions to “YELLOWSTONE ACADEMY SCHOOL ” Practice Location

Language	Start Address	Practice Location

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