Healthcare Provider Details

I. General information

NPI: 1760658405
Provider Name (Legal Business Name): FENNIMORE COMMUNITY SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 9TH ST
FENNIMORE WI
53809-1413
US

IV. Provider business mailing address

1397 9TH ST
FENNIMORE WI
53809-1413
US

V. Phone/Fax

Practice location:
  • Phone: 608-822-3243
  • Fax: 608-822-3250
Mailing address:
  • Phone: 608-822-3243
  • Fax: 608-822-3250

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: MR. RICHARD F FEUTZ
Title or Position: DISTRICT ADMINISTRATOR
Credential:
Phone: 608-822-3243