Provider Demographics
NPI:1427237023
Name:WATERTOWN UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:WATERTOWN UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KEISER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:920-262-1460
Mailing Address - Street 1:111 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53094-4434
Mailing Address - Country:US
Mailing Address - Phone:920-262-1460
Mailing Address - Fax:920-262-1469
Practice Address - Street 1:111 DODGE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-4434
Practice Address - Country:US
Practice Address - Phone:920-262-1460
Practice Address - Fax:920-262-1469
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
WI44206700Medicaid