Provider Demographics
NPI:1316155138
Name:EAST BERNARD ISD
Entity type:Organization
Organization Name:EAST BERNARD ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOLLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BODUNGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-532-6208
Mailing Address - Street 1:723 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BERNARD
Mailing Address - State:TX
Mailing Address - Zip Code:77435-7511
Mailing Address - Country:US
Mailing Address - Phone:979-335-7519
Mailing Address - Fax:
Practice Address - Street 1:723 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:EAST BERNARD
Practice Address - State:TX
Practice Address - Zip Code:77435-7511
Practice Address - Country:US
Practice Address - Phone:979-335-7519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065035002Medicare ID - Type Unspecified