Provider Demographics
NPI:1598022436
Name:PEASTER INDEPENDENT SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PEASTER INDEPENDENT SCHOOL DISTRICT
Other - Org Name:PEASTER ISD
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-341-5002
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:PEASTER
Mailing Address - State:TX
Mailing Address - Zip Code:76485-0129
Mailing Address - Country:US
Mailing Address - Phone:817-341-5000
Mailing Address - Fax:
Practice Address - Street 1:3602 HARWELL LAKE RD
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76088-8748
Practice Address - Country:US
Practice Address - Phone:817-341-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX064902202Medicaid