Basic Information
| Provider Information | |||||||||
| NPI: | 1215066089 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARSHFIELD R-1 SCHOOL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 114 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657062104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178592120 | ||||||||
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| Practice Location | |||||||||
| Address1: | 114 COMMERCIAL ST | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657062104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178592120 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WUTKE | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | SUPERINTENDENT | ||||||||
| AuthorizedOfficialTelephone: | 4178592120 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
No ID Information.