Healthcare Provider Details

I. General information

NPI: 1063548238
Provider Name (Legal Business Name): NEW WAVERLY ISD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 FRONT ST
NEW WAVERLY TX
77358-3527
US

IV. Provider business mailing address

355 FRONT ST
NEW WAVERLY TX
77358-3527
US

V. Phone/Fax

Practice location:
  • Phone: 936-344-6751
  • Fax:
Mailing address:
  • Phone: 936-344-6751
  • 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: MICHELLE CHITWOOD
Title or Position: FINANCIAL OFFICER
Credential:
Phone: 936-344-6751