Healthcare Provider Details

I. General information

NPI: 1194916403
Provider Name (Legal Business Name): CAMPBELLSPORT SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W SHEBOYGAN ST ATTN EILEEN STOFFEL
CAMPBELLSPORT WI
53010-2853
US

IV. Provider business mailing address

114 W SHEBOYGAN ST ATTN EILEEN STOFFEL
CAMPBELLSPORT WI
53010-2853
US

V. Phone/Fax

Practice location:
  • Phone: 920-533-3411
  • Fax: 920-533-8918
Mailing address:
  • Phone: 920-533-3411
  • Fax: 920-533-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT W THOM
Title or Position: BUSINESS MANAGER
Credential:
Phone: 920-533-8381