Provider Demographics
NPI:1174714018
Name:WAUPUN AREA SCHOOL DISTRICT
Entity type:Organization
Organization Name:WAUPUN AREA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-324-9341
Mailing Address - Street 1:950 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-2283
Mailing Address - Country:US
Mailing Address - Phone:920-324-9341
Mailing Address - Fax:
Practice Address - Street 1:950 WILCOX ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-2283
Practice Address - Country:US
Practice Address - Phone:920-324-9341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44227200Medicaid