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NPI Code Detail

MEDICARE: GRAPEVINE COLLEYVILLE ISD

MEDICARE: GRAPEVINE COLLEYVILLE 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
1251300000XLocal Education Agency (LEA)

General Provider Information

NPI Number : 1417078718
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRAPEVINE COLLEYVILLE ISD
Provider Business Mailing Address
First Line : 3051 IRA E WOODS AVE
Second Line :
City : GRAPEVINE
State : TX
Zip : 76051-3817
Country : US
Telephone Number : 817-251-5530
Fax Number :
Provider Business Practice Location Address
First Line : 3051 IRA E WOODS AVE
Second Line :
City : GRAPEVINE
State : TX
Zip : 76051-3817
Country : US
Telephone Number : 817-251-5530
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : DR. PEGGY WHEATON
Credential :
Telephone Number : 817-251-5530
Provider Enumeration Date : 04/03/2007
Last Update Date : 08/22/2020

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Directions to “GRAPEVINE COLLEYVILLE ISD ” Practice Location

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