Provider Demographics
NPI:1144494923
Name:PRAIRIE DU CHIEN AREA SCHOOL
Entity type:Organization
Organization Name:PRAIRIE DU CHIEN AREA SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-326-8451
Mailing Address - Street 1:420 S WACOUTA AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 S WACOUTA AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1924
Practice Address - Country:US
Practice Address - Phone:608-326-8451
Practice Address - Fax:608-326-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44204000Medicaid