Provider Demographics
NPI:1366621971
Name:MEDFORD SCHOOL DISTRICT
Entity type:Organization
Organization Name:MEDFORD SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-748-4620
Mailing Address - Street 1:124 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1760
Mailing Address - Country:US
Mailing Address - Phone:715-748-4620
Mailing Address - Fax:715-748-6839
Practice Address - Street 1:124 W STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1760
Practice Address - Country:US
Practice Address - Phone:715-748-4620
Practice Address - Fax:715-748-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44233100Medicaid