Provider Demographics
NPI:1124294301
Name:CASSVILLE SCHOOL DISTRICT
Entity type:Organization
Organization Name:CASSVILLE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZYDOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-725-5116
Mailing Address - Street 1:715 E AMELIA ST
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53806-9685
Mailing Address - Country:US
Mailing Address - Phone:608-725-5116
Mailing Address - Fax:608-725-2353
Practice Address - Street 1:715 E AMELIA ST
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53806-9685
Practice Address - Country:US
Practice Address - Phone:608-725-5116
Practice Address - Fax:608-725-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44234300Medicaid