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General NPI Number Information
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NPI Number | 1386784304
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Entity Type | Organization
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Legal Business Name | ASCENSION PROVIDENCE
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 405 LONDONDERRY DR STE 104
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City | WACO
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State | TX
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Zip | 76712-7920
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Country | US
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Telephone | 254-751-4915
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Fax | 254-751-4916
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Provider Business Mailing Address
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Address Line | 405 LONDONDERRY DR STE 104
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City | WACO
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State | TX
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Zip | 76712-7920
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Country | US
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Telephone | 254-751-4915
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Fax | 254-751-4916
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Authorized Official
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Title or Position | REG DIR NET REV & REIMB
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Name | JULIE L HOLLY
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Credential |
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Telephone | 210-410-2789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 14491
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License Number State | TX
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