=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962553024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEARY INDEPENDENT SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9500 W. NEW BOSTON RD
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-838-8960
-----------------------------------------------------
Fax | 903-838-6036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 519
-----------------------------------------------------
City | TEXARKANA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75504-0519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-838-8960
-----------------------------------------------------
Fax | 903-838-6036
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERINTENDENT
-----------------------------------------------------
Name | JIM TANKERSLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-838-8960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------