MEDICARE: RANDALL JOINT #1 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)

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	:	1689853657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL JOINT #1 SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	37101 87TH ST
Second Line	:
City	:	BURLINGTON
State	:	WI
Zip	:	53105-8596
Country	:	US
Telephone Number	:	262-537-2211
Fax Number	:	262-537-2280

Provider Business Practice Location Address
First Line	:	37101 87TH ST
Second Line	:
City	:	BURLINGTON
State	:	WI
Zip	:	53105-8596
Country	:	US
Telephone Number	:	262-537-2211
Fax Number	:	262-537-2280

Authorized Official
Title or Position	:	DISTRICT ADMINISTRATOR
Name	:	DR. STEVEN BLOOM
Credential	:
Telephone Number	:	262-537-2211

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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