Provider Demographics
NPI:1215116272
Name:BRISTOL SCHOOL DISTRICT #1
Entity type:Organization
Organization Name:BRISTOL SCHOOL DISTRICT #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-857-2334
Mailing Address - Street 1:20121 83RD ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:WI
Mailing Address - Zip Code:53104-9707
Mailing Address - Country:US
Mailing Address - Phone:262-857-2334
Mailing Address - Fax:262-857-6644
Practice Address - Street 1:20121 83RD ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:WI
Practice Address - Zip Code:53104-9707
Practice Address - Country:US
Practice Address - Phone:262-857-2334
Practice Address - Fax:262-857-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44204300Medicaid