Healthcare Provider Details

I. General information

NPI: 1689901613
Provider Name (Legal Business Name): HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 S 27TH ST
ABILENE TX
79605-6219
US

IV. Provider business mailing address

PO BOX 520
BROWNWOOD TX
76804-0520
US

V. Phone/Fax

Practice location:
  • Phone: 325-695-5440
  • Fax: 325-695-4505
Mailing address:
  • Phone: 325-643-3300
  • Fax: 325-641-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN WEST
Title or Position: CFO
Credential:
Phone: 325-643-3300