MEDICARE: KIMBERLY A WAUGH MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	G9398	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8F7704	OTHER	TX	BLUE CROSS
3	MDG9398	OTHER	TX	WORKERS COMPENSATION
4	126494104	OTHER		FIRSTCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265493316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A WAUGH MD

Provider Business Mailing Address
First Line	:	PO BOX 3780
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79116-3780
Country	:	US
Telephone Number	:	806-355-3352
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 MEDI PARK
Second Line	:	STE 2050
City	:	AMARILLO
State	:	TX
Zip	:	79106-2110
Country	:	US
Telephone Number	:	806-355-3352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	06/11/2008

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Directions to “ KIMBERLY A WAUGH MD” Practice Location

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