Provider Demographics
NPI:1235480062
Name:BROOKESMITH ISD
Entity Type:Organization
Organization Name:BROOKESMITH ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-643-4813
Mailing Address - Street 1:PO BOX 3336
Mailing Address - Street 2:
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76803-3336
Mailing Address - Country:US
Mailing Address - Phone:325-643-4813
Mailing Address - Fax:325-643-6403
Practice Address - Street 1:13400 FM 586 S.
Practice Address - Street 2:
Practice Address - City:BROOKESMITH
Practice Address - State:TX
Practice Address - Zip Code:76827-0706
Practice Address - Country:US
Practice Address - Phone:325-643-3023
Practice Address - Fax:325-643-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX025908Medicaid