MEDICARE: AVERY I.S.D.

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	:	1568582641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERY I.S.D.

Provider Business Mailing Address
First Line	:	1500 W MAIN ST
Second Line	:
City	:	CLARKSVILLE
State	:	TX
Zip	:	75426-3420
Country	:	US
Telephone Number	:	903-427-3891
Fax Number	:	903-427-3578

Provider Business Practice Location Address
First Line	:	1500 W MAIN ST
Second Line	:
City	:	CLARKSVILLE
State	:	TX
Zip	:	75426-3420
Country	:	US
Telephone Number	:	903-427-3891
Fax Number	:	903-427-3578

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL EDUCATION
Name	:	MRS. DENISE WAKE
Credential	:
Telephone Number	:	903-427-3891

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	08/22/2020

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