Healthcare Provider Details

I. General information

NPI: 1104005685
Provider Name (Legal Business Name): JOINT SCHOOL DISTRICT NO 2 CO CITY & TOWN OF BRILLION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MAIN STREET
BRILLION WI
54110-1294
US

IV. Provider business mailing address

315 S MAIN STREET
BRILLION WI
54110-1294
US

V. Phone/Fax

Practice location:
  • Phone: 920-756-2368
  • Fax: 920-756-3705
Mailing address:
  • Phone: 920-756-2368
  • Fax: 920-756-3705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: DR. DOMINICK MADISON
Title or Position: DISTRICT ADMINISTRATOR
Credential:
Phone: 920-756-2368