MEDICARE: BLACK HAWK SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093933137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACK HAWK SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	202 W CENTER ST
Second Line	:
City	:	SOUTH WAYNE
State	:	WI
Zip	:	53587-9509
Country	:	US
Telephone Number	:	608-439-5400
Fax Number	:	608-439-1022

Provider Business Practice Location Address
First Line	:	202 W CENTER ST
Second Line	:
City	:	SOUTH WAYNE
State	:	WI
Zip	:	53587-9509
Country	:	US
Telephone Number	:	608-439-5400
Fax Number	:	608-439-1022

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. KEVIN SHETLER
Credential	:
Telephone Number	:	608-439-5400

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	08/22/2020

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Directions to “BLACK HAWK SCHOOL DISTRICT ” Practice Location

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