Healthcare Provider Details

I. General information

NPI: 1417101171
Provider Name (Legal Business Name): CENTRAL TEXAS URGENT CARE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HEWITT DR 203
WACO TX
76712-8833
US

IV. Provider business mailing address

1201 HEWITT DR 203
WACO TX
76712-8833
US

V. Phone/Fax

Practice location:
  • Phone: 254-666-3627
  • Fax:
Mailing address:
  • Phone: 254-666-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberL2082
License Number StateTX

VIII. Authorized Official

Name: DR. FOY EDWARD DARK
Title or Position: OWNER
Credential: D.O.
Phone: 254-666-3627