MEDICARE: HEART OF TEXAS OUTPATIENT CATARACT CENTER, INC.

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	261QS0132X	Ophthalmologic Surgery Clinic/Center	170	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	490002105	OTHER	TX	PALMETTO GBA RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	HH1285	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790784726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART OF TEXAS OUTPATIENT CATARACT CENTER, INC.

Provider Business Mailing Address
First Line	:	100 S PARK DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5918
Country	:	US
Telephone Number	:	325-643-3561
Fax Number	:	325-646-0670

Provider Business Practice Location Address
First Line	:	100 S PARK DR
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76801-5918
Country	:	US
Telephone Number	:	325-643-3561
Fax Number	:	325-646-0670

Authorized Official
Title or Position	:	MEDICAL SECRETARY
Name	:	DIANE NEWTON
Credential	:
Telephone Number	:	325-643-3561

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/17/2010

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Directions to “HEART OF TEXAS OUTPATIENT CATARACT CENTER, INC. ” Practice Location

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