Healthcare Provider Details

I. General information

NPI: 1639304033
Provider Name (Legal Business Name): HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 S 14TH ST
ABILENE TX
79605-4733
US

IV. Provider business mailing address

PO BOX 520
BROWNWOOD TX
76804-0520
US

V. Phone/Fax

Practice location:
  • Phone: 325-795-1200
  • Fax: 325-795-1202
Mailing address:
  • Phone: 325-643-3300
  • Fax: 325-641-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN WEST
Title or Position: COO
Credential:
Phone: 325-643-3300