Provider Demographics
NPI:1962625913
Name:OCONOMOWOC AREA SCHOOL DISTRICT
Entity type:Organization
Organization Name:OCONOMOWOC AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-560-2140
Mailing Address - Street 1:W360 N7077 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1197
Mailing Address - Country:US
Mailing Address - Phone:262-560-2140
Mailing Address - Fax:920-474-7595
Practice Address - Street 1:W360 N7077 BROWN ST
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1197
Practice Address - Country:US
Practice Address - Phone:262-560-2139
Practice Address - Fax:920-474-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44208700Medicaid