Healthcare Provider Details

I. General information

NPI: 1770709867
Provider Name (Legal Business Name): GILBRALTAR AREA SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 HIGHWAY 42
FISH CREEK WI
54212-9755
US

IV. Provider business mailing address

3924 HIGHWAY 42
FISH CREEK WI
54212-9755
US

V. Phone/Fax

Practice location:
  • Phone: 920-868-3284
  • Fax: 920-868-2417
Mailing address:
  • Phone: 920-868-3284
  • Fax: 920-868-2417

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: DR. STEPHEN SEYFER
Title or Position: DISTRICT SUPERINTENDENT
Credential:
Phone: 920-868-3284