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1600 Providence Dr Waco TX 76707-2261 | |
| (254) 313-4200 | |
| (254) 313-4531 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1600 Providence Dr, Waco, Texas |
| Authorized Official Name and Position | Annette Ballew (CFO) |
| Authorized Official Contact | 2543134282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1600 Providence Dr Waco TX 76707-2261 Ph: (254) 313-4200 | 1600 Providence Dr Waco TX 76707-2261 Ph: (254) 313-4200 |
| NPI Number | 1689651440 |
|---|---|
| Provider Enumeration Date | 12/22/2005 |
| Last Update Date | 07/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689651440 | NPI | - | NPPES |
| 121447001 | Medicaid | TX | |
| 121447002 | Medicaid | TX | |
| 121447003 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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