Provider Demographics
NPI:1699804500
Name:COUNTY OF GALLATIN - SCHOOL DISTRICT 3
Entity type:Organization
Organization Name:COUNTY OF GALLATIN - SCHOOL DISTRICT 3
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSIST. SUPERINTENDENT OF BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-522-6042
Mailing Address - Street 1:416 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-2354
Mailing Address - Country:US
Mailing Address - Phone:406-522-6011
Mailing Address - Fax:406-522-6090
Practice Address - Street 1:416 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:MT
Practice Address - Zip Code:59741-2354
Practice Address - Country:US
Practice Address - Phone:406-522-6011
Practice Address - Fax:406-522-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0165230Medicaid