Provider Demographics
NPI:1528389434
Name:HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
Other - Org Name:RIVERSIDE DENTAL 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 1:225 W WACO DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-3836
Practice Address - Country:US
Practice Address - Phone:254-750-5487
Practice Address - Fax:
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
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092957202Medicaid
TXFQ0000676OtherMEDICAID
TX671873Medicare Oscar/Certification