Healthcare Provider Details

I. General information

NPI: 1912093832
Provider Name (Legal Business Name): HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 WEST WALLACE
SAN SABA TX
76877-4433
US

IV. Provider business mailing address

PO BOX 520
BROWNWOOD TX
76804-0520
US

V. Phone/Fax

Practice location:
  • Phone: 325-372-5701
  • Fax: 325-372-3249
Mailing address:
  • Phone: 325-643-3300
  • Fax: 325-641-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberJ1912
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ1912
License Number StateTX

VIII. Authorized Official

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