Provider Demographics
NPI:1326369232
Name:HEART OF TEXAS COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:HEART OF TEXAS COMMUNITY HEALTH CENTER
Other - Org Name:CONNALLY COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:254-750-8202
Mailing Address - Street 1:1600 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2261
Mailing Address - Country:US
Mailing Address - Phone:254-750-8200
Mailing Address - Fax:254-750-8326
Practice Address - Street 1:715 N RITA ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-1140
Practice Address - Country:US
Practice Address - Phone:254-412-2101
Practice Address - Fax:254-412-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092957202Medicaid
TXFQ0000676OtherMEDICAID
TX092957202Medicaid