Provider Demographics
NPI:1851848402
Name:EAGLE MOUNTAIN SAGINAW ISD
Entity Type:Organization
Organization Name:EAGLE MOUNTAIN SAGINAW ISD
Other - Org Name:SAGINAW HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:SCHOOL DISTRICT ATHLETIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-232-0880
Mailing Address - Street 1:800 N BLUE MOUND RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131
Mailing Address - Country:US
Mailing Address - Phone:505-977-0419
Mailing Address - Fax:
Practice Address - Street 1:800 N BLUE MOUND RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-1052
Practice Address - Country:US
Practice Address - Phone:505-977-0419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT6567251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare