MEDICARE: BLOOMING GROVE 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)

General Provider Information

NPI Number	:	1639521735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMING GROVE ISD

Provider Business Mailing Address
First Line	:	PO BOX 258
Second Line	:
City	:	BLOOMING GROVE
State	:	TX
Zip	:	76626-0258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 W GRADY ST
Second Line	:
City	:	BLOOMING GROVE
State	:	TX
Zip	:	76626-3010
Country	:	US
Telephone Number	:	903-389-3372
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIR OF SPECIAL EDUCATION
Name	:	PAT HARPER
Credential	:
Telephone Number	:	903-389-3372

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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Directions to “BLOOMING GROVE ISD ” Practice Location

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