| Elm Avenue Community Clinic | |
|
609 Elm St Waco TX 76704-2516 | |
| (254) 313-6900 | |
| (254) 313-6959 |
| Full Name | Elm Avenue Community Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 609 Elm St, Waco, Texas |
| Authorized Official Name and Position | Annette Ballew (CFO) |
| Authorized Official Contact | 2543134282 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elm Avenue Community Clinic 1600 Providence Dr Waco TX 76707-2261 Ph: (254) 313-4200 | Elm Avenue Community Clinic 609 Elm St Waco TX 76704-2516 Ph: (254) 313-6900 |
| NPI Number | 1700055639 |
|---|---|
| Provider Enumeration Date | 02/25/2008 |
| Last Update Date | 07/28/2017 |
| Medicare PECOS PAC ID | 1153370242 |
|---|---|
| Medicare Enrollment ID | O20091014000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700055639 | NPI | - | NPPES |
| 092957202 | Medicaid | TX | |
| FQ0000676 | Medicaid | TX | |
| 286210401 | Medicaid | TX | |
| 06816A | Other | TX | MEDICARE SITE ID |
| 092957203 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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