Provider Demographics
NPI:1538206628
Name:COUNTY OF TELLER SCHOOL DISTRICT RE1
Entity type:Organization
Organization Name:COUNTY OF TELLER SCHOOL DISTRICT RE1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, SFO
Authorized Official - Phone:719-689-2685
Mailing Address - Street 1:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:CRIPPLE CREEK
Mailing Address - State:CO
Mailing Address - Zip Code:80813-0897
Mailing Address - Country:US
Mailing Address - Phone:719-689-2661
Mailing Address - Fax:719-689-2256
Practice Address - Street 1:410 N. B ST.
Practice Address - Street 2:
Practice Address - City:CRIPPLE CREEK
Practice Address - State:CO
Practice Address - Zip Code:80813-0897
Practice Address - Country:US
Practice Address - Phone:719-689-2661
Practice Address - Fax:719-689-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99388235Medicaid