Provider Demographics
NPI:1063890655
Name:MIAMI ISD
Entity type:Organization
Organization Name:MIAMI ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:POAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-868-3971
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:TX
Mailing Address - Zip Code:79059-0368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 WARRIOR LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:TX
Practice Address - Zip Code:79059-0368
Practice Address - Country:US
Practice Address - Phone:806-868-3971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid