MEDICARE: SHEPHERD 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	:	1609082445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEPHERD I S D

Provider Business Mailing Address
First Line	:	1401 S BYRD AVE
Second Line	:
City	:	SHEPHERD
State	:	TX
Zip	:	77371-3582
Country	:	US
Telephone Number	:	936-628-3396
Fax Number	:	936-628-3841

Provider Business Practice Location Address
First Line	:	1401 S BYRD AVE
Second Line	:
City	:	SHEPHERD
State	:	TX
Zip	:	77371-3582
Country	:	US
Telephone Number	:	936-628-3396
Fax Number	:	936-628-3841

Authorized Official
Title or Position	:	ASST. SUPERINTENDENT FOR SP PROG
Name	:	MRS. DIANA KELM
Credential	:
Telephone Number	:	936-628-3396

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	09/11/2007

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Directions to “SHEPHERD I S D ” Practice Location

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