Provider Demographics
NPI:1518492891
Name:BREMOND ISD
Entity Type:Organization
Organization Name:BREMOND ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-746-7145
Mailing Address - Street 1:601 W COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:BREMOND
Mailing Address - State:TX
Mailing Address - Zip Code:76629-4687
Mailing Address - Country:US
Mailing Address - Phone:254-746-7145
Mailing Address - Fax:
Practice Address - Street 1:601 W COLLINS ST
Practice Address - Street 2:
Practice Address - City:BREMOND
Practice Address - State:TX
Practice Address - Zip Code:76629-4687
Practice Address - Country:US
Practice Address - Phone:254-746-7145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid