Provider Demographics
NPI:1063058121
Name:ROSEVILLE INDEPENDENT SCHOOL DISTRICT 623
Entity type:Organization
Organization Name:ROSEVILLE INDEPENDENT SCHOOL DISTRICT 623
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THIRD PARTY BILLING / FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-635-1658
Mailing Address - Street 1:1251 COUNTY ROAD B2 W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3205
Mailing Address - Country:US
Mailing Address - Phone:651-635-1658
Mailing Address - Fax:
Practice Address - Street 1:1251 COUNTY ROAD B2 W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3205
Practice Address - Country:US
Practice Address - Phone:651-635-1658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)