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NPI Code Detail

MEDICARE: PROVIDENCE HEALTH SERVICES OF WACO

MEDICARE: PROVIDENCE HEALTH SERVICES OF WACO
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
1261Q00000XClinic/Center000040TX

General Provider Information

NPI Number : 1306872213
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE HEALTH SERVICES OF WACO
Provider Business Mailing Address
First Line : PO BOX 2589
Second Line :
City : WACO
State : TX
Zip : 76702-2589
Country : US
Telephone Number : 254-751-4146
Fax Number : 254-751-4283
Provider Business Practice Location Address
First Line : 322 COLEMAN ST
Second Line :
City : MARLIN
State : TX
Zip : 76661-2358
Country : US
Telephone Number : 254-751-4146
Fax Number : 254-751-4283
Authorized Official
Title or Position : SR. VP CFO
Name : MRS. CHERYL A SADRO
Credential :
Telephone Number : 254-751-4146
Provider Enumeration Date : 06/23/2006
Last Update Date : 08/22/2020

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Directions to “PROVIDENCE HEALTH SERVICES OF WACO ” Practice Location

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