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NPI Code Detail

MEDICARE: EAST TROY COMMUNITY SCHOOL DISTRICT

MEDICARE: EAST TROY COMMUNITY 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
1251300000XLocal Education Agency (LEA)

Other Identifiers

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

General Provider Information

NPI Number : 1558536805
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST TROY COMMUNITY SCHOOL DISTRICT
Provider Business Mailing Address
First Line : 2043 DIVISION ST
Second Line :
City : EAST TROY
State : WI
Zip : 53120-1238
Country : US
Telephone Number : 262-642-6710
Fax Number : 262-642-6712
Provider Business Practice Location Address
First Line : 2043 DIVISION ST
Second Line :
City : EAST TROY
State : WI
Zip : 53120-1238
Country : US
Telephone Number : 262-642-6710
Fax Number : 262-642-6712
Authorized Official
Title or Position : BUSINESS MANAGER
Name : MR. KEITH ROBERT BRIGHTMAN
Credential :
Telephone Number : 262-642-6710
Provider Enumeration Date : 04/28/2008
Last Update Date : 04/28/2008

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Directions to “EAST TROY COMMUNITY SCHOOL DISTRICT ” Practice Location

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