MEDICARE: BIRDVILLE ISD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1003934837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIRDVILLE ISD

Provider Business Mailing Address
First Line	:	6125 E BELKNAP ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117-4204
Country	:	US
Telephone Number	:	817-547-5712
Fax Number	:

Provider Business Practice Location Address
First Line	:	6125 E BELKNAP ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76117-4204
Country	:	US
Telephone Number	:	817-547-5712
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. BETTY GRUBBS
Credential	:
Telephone Number	:	817-547-5712

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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