Healthcare Provider Details

I. General information

NPI: 1982607735
Provider Name (Legal Business Name): WACO CARDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 NEW SANGER AVE STE A
WACO TX
76712-4054
US

IV. Provider business mailing address

PO BOX 21327
WACO TX
76702-1327
US

V. Phone/Fax

Practice location:
  • Phone: 254-399-5400
  • Fax: 254-772-8669
Mailing address:
  • Phone: 254-399-5400
  • Fax: 254-772-8669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARK MCCOWN
Title or Position: CEO
Credential:
Phone: 254-399-5434