MEDICARE: BAINBRIDGE ISLAND 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	:	1861421646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAINBRIDGE ISLAND SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	8489 MADISON AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2915
Country	:	US
Telephone Number	:	206-842-2907
Fax Number	:	206-780-1089

Provider Business Practice Location Address
First Line	:	8489 MADISON AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2915
Country	:	US
Telephone Number	:	206-842-2907
Fax Number	:	206-780-1089

Authorized Official
Title or Position	:	ASST. SUPERINTENDENT I. SUPPORT SER
Name	:	MR. CLAYTON R MORK
Credential	:	PH.D.
Telephone Number	:	206-780-1069

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	08/22/2020

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