MEDICARE: CAMPBELLSPORT 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	:	1194916403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMPBELLSPORT SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	114 W SHEBOYGAN ST
Second Line	:	ATTN EILEEN STOFFEL
City	:	CAMPBELLSPORT
State	:	WI
Zip	:	53010-2853
Country	:	US
Telephone Number	:	920-533-3411
Fax Number	:	920-533-8918

Provider Business Practice Location Address
First Line	:	114 W SHEBOYGAN ST
Second Line	:	ATTN EILEEN STOFFEL
City	:	CAMPBELLSPORT
State	:	WI
Zip	:	53010-2853
Country	:	US
Telephone Number	:	920-533-3411
Fax Number	:	920-533-8918

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	ROBERT W THOM
Credential	:
Telephone Number	:	920-533-8381

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	07/30/2008

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