Provider Demographics
NPI:1750423372
Name:MARTINS MILL I S D
Entity type:Organization
Organization Name:MARTINS MILL I S D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-479-3872
Mailing Address - Street 1:301 FM 1861
Mailing Address - Street 2:
Mailing Address - City:BEN WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:75754-8407
Mailing Address - Country:US
Mailing Address - Phone:903-479-3872
Mailing Address - Fax:903-473-3711
Practice Address - Street 1:301 FM 1861
Practice Address - Street 2:
Practice Address - City:BEN WHEELER
Practice Address - State:TX
Practice Address - Zip Code:75754-8407
Practice Address - Country:US
Practice Address - Phone:903-479-3872
Practice Address - Fax:903-473-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065022802Medicaid