Healthcare Provider Details

I. General information

NPI: 1437183217
Provider Name (Legal Business Name): HEART OF TEXAS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 LONDONDERRY DR STE 201
WACO TX
76712-7924
US

IV. Provider business mailing address

PO BOX 938
KILLEEN TX
76540-0938
US

V. Phone/Fax

Practice location:
  • Phone: 254-399-8364
  • Fax: 254-399-9116
Mailing address:
  • Phone: 254-634-6999
  • Fax: 254-200-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN S CHAKMAKJIAN
Title or Position: OWNER
Credential: M.D.
Phone: 254-399-8364