Provider Demographics
NPI:1194916403
Name:CAMPBELLSPORT SCHOOL DISTRICT
Entity type:Organization
Organization Name:CAMPBELLSPORT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:THOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-533-8381
Mailing Address - Street 1:114 W SHEBOYGAN ST
Mailing Address - Street 2:ATTN EILEEN STOFFEL
Mailing Address - City:CAMPBELLSPORT
Mailing Address - State:WI
Mailing Address - Zip Code:53010-2853
Mailing Address - Country:US
Mailing Address - Phone:920-533-3411
Mailing Address - Fax:920-533-8918
Practice Address - Street 1:114 W SHEBOYGAN ST
Practice Address - Street 2:ATTN EILEEN STOFFEL
Practice Address - City:CAMPBELLSPORT
Practice Address - State:WI
Practice Address - Zip Code:53010-2853
Practice Address - Country:US
Practice Address - Phone:920-533-3411
Practice Address - Fax:920-533-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44225400Medicaid