Provider Demographics
NPI:1235509746
Name:WACO HEART AND SURGERY CENTER LLC
Entity Type:Organization
Organization Name:WACO HEART AND SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:MYATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-218-3350
Mailing Address - Street 1:7003 WOODWAY DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6170
Mailing Address - Country:US
Mailing Address - Phone:254-218-3350
Mailing Address - Fax:254-218-3351
Practice Address - Street 1:7003 WOODWAY DR
Practice Address - Street 2:SUITE 310
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6170
Practice Address - Country:US
Practice Address - Phone:254-218-3350
Practice Address - Fax:254-218-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical