1306166830 NPI number — HEART OF TEXAS COMMUNITY HEALTH CENTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306166830 NPI number — HEART OF TEXAS COMMUNITY HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCGREGOR COMMUNITY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306166830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 PROVIDENCE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76707-2261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-313-4200
Provider Business Mailing Address Fax Number:
254-313-4326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 JOHNSON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC GREGOR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76657-1441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-313-5200
Provider Business Practice Location Address Fax Number:
254-313-5299
Provider Enumeration Date:
06/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BALLEW
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
254-313-4282

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 289056801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: FQ0000676 . This is a "MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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