MEDICARE: WALL ISD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)	0649964	TX

General Provider Information

NPI Number	:	1477672368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALL ISD

Provider Business Mailing Address
First Line	:	3132 EXECUTIVE DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6802
Country	:	US
Telephone Number	:	325-947-0939
Fax Number	:	325-947-0456

Provider Business Practice Location Address
First Line	:	3132 EXECUTIVE DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-6802
Country	:	US
Telephone Number	:	325-947-0939
Fax Number	:	325-947-0456

Authorized Official
Title or Position	:	DIRECTOR
Name	:	NINA L. REID
Credential	:
Telephone Number	:	325-947-0939

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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Directions to “WALL ISD ” Practice Location

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