Healthcare Provider Details

I. General information

NPI: 1417335761
Provider Name (Legal Business Name): ZAVALLA ISD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 E MAIN ST
ZAVALLA TX
75980-9258
US

IV. Provider business mailing address

431 E MAIN ST
ZAVALLA TX
75980-9258
US

V. Phone/Fax

Practice location:
  • Phone: 936-897-2271
  • Fax:
Mailing address:
  • Phone:
  • 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: ALICE BOULWARE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 936-897-2674