Provider Demographics
NPI:1023365848
Name:GOLD-BURG INDEPENDENT SCHOOL DISTRICT
Entity Type:Organization
Organization Name:GOLD-BURG INDEPENDENT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-872-3562
Mailing Address - Street 1:468 PRATER RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-6417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:468 PRATER RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-6417
Practice Address - Country:US
Practice Address - Phone:940-872-3562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid