| South 18th Street Community Clinic | |
|
1800 Gurley Ln Waco TX 76706-4025 | |
| (254) 313-6000 | |
| (254) 313-6099 |
| Full Name | South 18th Street Community Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1800 Gurley Ln, 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 |
|---|---|
| South 18th Street Community Clinic 1600 Providence Dr Waco TX 76707-2261 Ph: (254) 313-4200 | South 18th Street Community Clinic 1800 Gurley Ln Waco TX 76706-4025 Ph: (254) 313-6000 |
| NPI Number | 1699096503 |
|---|---|
| Provider Enumeration Date | 06/15/2010 |
| Last Update Date | 07/28/2017 |
| Medicare PECOS PAC ID | 1153370242 |
|---|---|
| Medicare Enrollment ID | O20080205000574 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699096503 | NPI | - | NPPES |
| FQ0000676 | Other | TX | MEDICAID |
| 285245101 | 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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