MEDICARE: HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA

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	261QR1300X	Rural Health Clinic/Center	J1912	TX
2	207Q00000X	Family Medicine Physician	J1912	TX

General Provider Information

NPI Number	:	1912093832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	PO BOX 520
Second Line	:
City	:	BROWNWOOD
State	:	TX
Zip	:	76804-0520
Country	:	US
Telephone Number	:	325-643-3300
Fax Number	:	325-641-8714

Provider Business Practice Location Address
First Line	:	403 WEST WALLACE
Second Line	:
City	:	SAN SABA
State	:	TX
Zip	:	76877-4433
Country	:	US
Telephone Number	:	325-372-5701
Fax Number	:	325-372-3249

Authorized Official
Title or Position	:	CFO
Name	:	BRYAN WEST
Credential	:
Telephone Number	:	325-643-3300

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	09/09/2008

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