Provider Demographics
NPI:1700917382
Name:BLOOMBURG ISD
Entity type:Organization
Organization Name:BLOOMBURG ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RATCLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-728-5216
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:BLOOMBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75556-0156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:307 W. CYPRESS
Practice Address - Street 2:
Practice Address - City:BLOOMBURG
Practice Address - State:TX
Practice Address - Zip Code:75556
Practice Address - Country:US
Practice Address - Phone:903-728-5216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX064406402Medicaid