Provider Demographics
NPI:1447470745
Name:MATAGORDA ISD
Entity type:Organization
Organization Name:MATAGORDA ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-863-7693
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:MATAGORDA
Mailing Address - State:TX
Mailing Address - Zip Code:77457-0657
Mailing Address - Country:US
Mailing Address - Phone:979-863-7693
Mailing Address - Fax:
Practice Address - Street 1:717 WIGHTMAN
Practice Address - Street 2:
Practice Address - City:MATAGORDA
Practice Address - State:TX
Practice Address - Zip Code:77457
Practice Address - Country:US
Practice Address - Phone:979-863-7693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0648081-02Medicaid