Provider Demographics
NPI:1245750447
Name:PADUCAH ISD
Entity Type:Organization
Organization Name:PADUCAH ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-492-3524
Mailing Address - Street 1:PO BOX P
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:TX
Mailing Address - Zip Code:79248-1183
Mailing Address - Country:US
Mailing Address - Phone:806-492-3524
Mailing Address - Fax:
Practice Address - Street 1:810 GOODWIN AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:TX
Practice Address - Zip Code:79248-1183
Practice Address - Country:US
Practice Address - Phone:806-492-3524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid