MEDICARE: HEART OF TEXAS COMMUNITY HEALTH CENTER, INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	172V00000X	Community Health Worker
3	207Q00000X	Family Medicine Physician
4	261QF0400X	Federally Qualified Health Center (FQHC)

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	068160	OTHER	TX	UNIFORM DATA SET
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1164409926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART OF TEXAS COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	1600 PROVIDENCE DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76707-2261
Country	:	US
Telephone Number	:	254-313-4200
Fax Number	:	254-313-4326

Provider Business Practice Location Address
First Line	:	1600 PROVIDENCE DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76707-2261
Country	:	US
Telephone Number	:	254-313-4200
Fax Number	:	254-313-4531

Authorized Official
Title or Position	:	CFO
Name	:	MRS. ANNETTE BALLEW
Credential	:	CPA
Telephone Number	:	254-313-4282

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	02/13/2025

1600 PROVIDENCE DR , FAMILY PRACTICE CENTER
WACO, TX
76707-2261

Practice Phone: 254-750-8200
Practice Fax: 254-750-8383