Provider Demographics
NPI:1770668543
Name:HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA
Entity Type:Organization
Organization Name:HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA
Other - Org Name:ONE SOURCE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:325-643-3300
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-0520
Mailing Address - Country:US
Mailing Address - Phone:325-643-3300
Mailing Address - Fax:325-641-8714
Practice Address - Street 1:2005 HIGHWAY 183 NORTH
Practice Address - Street 2:
Practice Address - City:EARLY
Practice Address - State:TX
Practice Address - Zip Code:76802-2157
Practice Address - Country:US
Practice Address - Phone:325-643-3010
Practice Address - Fax:325-643-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1912207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673895Medicare Oscar/Certification