Healthcare Provider Details

I. General information

NPI: 1750402921
Provider Name (Legal Business Name): KIRBYVILLE ISD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S MARGARET AVE
KIRBYVILLE TX
75956-2711
US

IV. Provider business mailing address

PO BOX 1087
BUNA TX
77612-1087
US

V. Phone/Fax

Practice location:
  • Phone: 409-423-4275
  • Fax:
Mailing address:
  • Phone: 409-994-4896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOYCE HALL
Title or Position: DIRECTOR
Credential:
Phone: 409-994-4896