Provider Demographics
NPI:1558349399
Name:HEART OF TEXAS HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:HEART OF TEXAS HEALTHCARE SYSTEM
Other - Org Name:HEART OF TEXAS MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-597-2901
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:TX
Mailing Address - Zip Code:76825-1150
Mailing Address - Country:US
Mailing Address - Phone:325-597-2901
Mailing Address - Fax:325-597-2280
Practice Address - Street 1:2008 NINE RD
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-7210
Practice Address - Country:US
Practice Address - Phone:325-597-2901
Practice Address - Fax:325-597-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000362207P00000X
TX282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138715115Medicaid
TX322916301Medicaid
HH0156OtherBLUE CROSS
TX322916301Medicaid
TX45Z348Medicare Oscar/Certification
TX451348Medicare Oscar/Certification