Provider Demographics
NPI:1245569201
Name:HEART OF TEXAS COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:HEART OF TEXAS COMMUNITY HEALTH CENTER INC
Other - Org Name:WACO FAMILY MEDICINE - PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-313-4412
Mailing Address - Street 1:1600 PROVIDENCE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2261
Mailing Address - Country:US
Mailing Address - Phone:254-313-4307
Mailing Address - Fax:254-313-4467
Practice Address - Street 1:1600 PROVIDENCE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-2261
Practice Address - Country:US
Practice Address - Phone:254-313-4307
Practice Address - Fax:254-313-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4554615OtherNCPDP PROVIDER IDENTIFICATION NUMBER