Provider Demographics
NPI:1003844531
Name:WACO INFECTIOUS DISEASE ASSOCIATES P A
Entity Type:Organization
Organization Name:WACO INFECTIOUS DISEASE ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:FARLEY
Authorized Official - Last Name:VERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-741-1860
Mailing Address - Street 1:7030 NEW SANGER AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-741-1860
Mailing Address - Fax:254-741-1249
Practice Address - Street 1:7030 NEW SANGER AVE
Practice Address - Street 2:STE 202
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-741-1860
Practice Address - Fax:254-741-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094993501Medicaid
TX00GT32Medicare ID - Type Unspecified