Provider Demographics
NPI:1255853008
Name:IOLA ISD
Entity Type:Organization
Organization Name:IOLA ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-394-2361
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:TX
Mailing Address - Zip Code:77861-0159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7282 FORT WORTH AVE
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:TX
Practice Address - Zip Code:77861-5445
Practice Address - Country:US
Practice Address - Phone:936-394-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid