Provider Demographics
NPI:1801927264
Name:PECOS INDEPENDENT SCHOOL DISTRICT
Entity type:Organization
Organization Name:PECOS INDEPENDENT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-757-4700
Mailing Address - Street 1:NORTH HIGHWAY 63
Mailing Address - Street 2:PECOS INDEPENDENT SCHOOL DISTRICT
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552
Mailing Address - Country:US
Mailing Address - Phone:505-757-4700
Mailing Address - Fax:505-757-8721
Practice Address - Street 1:PECOS INDEPENDENT SCHOOL DISTRICT
Practice Address - Street 2:NORTH HIGHWAY 63
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552
Practice Address - Country:US
Practice Address - Phone:505-757-4700
Practice Address - Fax:505-757-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP2767Medicaid