Provider Demographics
NPI:1518175967
Name:ITALY INDEPENDENT SCHOOL DISTRICT
Entity Type:Organization
Organization Name:ITALY INDEPENDENT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTTRULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-483-1815
Mailing Address - Street 1:300 COLLEGE
Mailing Address - Street 2:
Mailing Address - City:ITALY
Mailing Address - State:TX
Mailing Address - Zip Code:76651-3775
Mailing Address - Country:US
Mailing Address - Phone:972-483-1815
Mailing Address - Fax:
Practice Address - Street 1:300 COLLEGE
Practice Address - Street 2:
Practice Address - City:ITALY
Practice Address - State:TX
Practice Address - Zip Code:76651-3775
Practice Address - Country:US
Practice Address - Phone:972-483-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX064505302Medicaid