Healthcare Provider Details

I. General information

NPI: 1164742680
Provider Name (Legal Business Name): HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BELLMEAD DR
BELLMEAD TX
76705-3081
US

IV. Provider business mailing address

1600 PROVIDENCE DR
WACO TX
76707-2261
US

V. Phone/Fax

Practice location:
  • Phone: 254-313-5400
  • Fax: 254-313-5499
Mailing address:
  • Phone: 254-313-4200
  • Fax: 254-313-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNETTE BALLEW
Title or Position: CFO
Credential: CPA
Phone: 254-313-4282