Healthcare Provider Details

I. General information

NPI: 1417070178
Provider Name (Legal Business Name): BLOOMINGTON I.S.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FM 616 2875
BLOOMINGTON TX
77951-0158
US

IV. Provider business mailing address

PO BOX 158
BLOOMINGTON TX
77951-0158
US

V. Phone/Fax

Practice location:
  • Phone: 361-897-1652
  • Fax:
Mailing address:
  • Phone: 361-897-1652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. SUZANNE WESSON
Title or Position: SUPERINTENDENT
Credential: PH.D.
Phone: 361-897-1652