Provider Demographics
NPI:1417732371
Name:HEART OF TEXAS DIRECT PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:HEART OF TEXAS DIRECT PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:254-218-4002
Mailing Address - Street 1:2040 N VALLEY MILLS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2561
Mailing Address - Country:US
Mailing Address - Phone:254-218-4002
Mailing Address - Fax:254-323-2692
Practice Address - Street 1:2040 N VALLEY MILLS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2561
Practice Address - Country:US
Practice Address - Phone:254-218-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care