MEDICARE: METHODIST CHILDREN'S HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3571	TX
2	103TS0200X	School Psychologist	30212	TX
3	101YP2500X	Professional Counselor
4	1041C0700X	Clinical Social Worker
5	164X00000X	Licensed Vocational Nurse
6	163W00000X	Registered Nurse
7	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1083949903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST CHILDREN'S HOME

Provider Business Mailing Address
First Line	:	1111 HERRING AVENUE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3642
Country	:	US
Telephone Number	:	254-753-0181
Fax Number	:	254-755-7609

Provider Business Practice Location Address
First Line	:	1111 HERRING AVE
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3642
Country	:	US
Telephone Number	:	254-753-0181
Fax Number	:	254-755-7609

Authorized Official
Title or Position	:	INTERIM PRESIDENT
Name	:	MR. TIM BROWN
Credential	:
Telephone Number	:	254-753-0181

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	05/25/2010

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Directions to “METHODIST CHILDREN'S HOME ” Practice Location

Language	Start Address	Practice Location

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