MEDICARE: MT. BAKER 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)		WA

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	:	1407954530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. BAKER SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	4956 A DEMING ROAD
Second Line	:	PO BOX 95
City	:	DEMING
State	:	WA
Zip	:	98244
Country	:	US
Telephone Number	:	360-383-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4956 A DEMING ROAD
Second Line	:
City	:	DEMING
State	:	WA
Zip	:	98244
Country	:	US
Telephone Number	:	360-383-2000
Fax Number	:

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	MR. RICHARD GANTMAN
Credential	:
Telephone Number	:	360-383-2000

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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