Healthcare Provider Details

I. General information

NPI: 1912173584
Provider Name (Legal Business Name): SCHOOL DISTRICT OF CUBA CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 W ROOSEVELT ST 101 N. SCHOOL STREET
CUBA CITY WI
53807-1220
US

IV. Provider business mailing address

518 W ROOSEVELT ST 101 N. SCHOOL STREET
CUBA CITY WI
53807-1220
US

V. Phone/Fax

Practice location:
  • Phone: 608-744-2174
  • Fax: 608-744-7469
Mailing address:
  • Phone: 608-744-2174
  • Fax: 608-744-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: MS. DEB DURLEY
Title or Position: SPECIAL EDUCATION DESIGNEE
Credential:
Phone: 608-744-2174