Provider Demographics
NPI:1760860878
Name:BOYS RANCH ISD
Entity Type:Organization
Organization Name:BOYS RANCH ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEIMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-534-2221
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BOYS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:79010-0219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:BOYS RANCH
Practice Address - State:TX
Practice Address - Zip Code:79010-0219
Practice Address - Country:US
Practice Address - Phone:806-534-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid