Provider Demographics
NPI:1730354762
Name:SEVASTOPOL SCHOOL DISTRICT
Entity type:Organization
Organization Name:SEVASTOPOL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROMELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-743-6282
Mailing Address - Street 1:4550 HIGHWAY 57
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-8599
Mailing Address - Country:US
Mailing Address - Phone:920-743-6282
Mailing Address - Fax:920-743-4009
Practice Address - Street 1:4550 HIGHWAY 57
Practice Address - Street 2:SEVASTOPOL SCHOOL DISTRICT
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-8599
Practice Address - Country:US
Practice Address - Phone:920-743-6282
Practice Address - Fax:920-743-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44206800Medicaid