Provider Demographics
NPI:1790784726
Name:HEART OF TEXAS OUTPATIENT CATARACT CENTER, INC.
Entity Type:Organization
Organization Name:HEART OF TEXAS OUTPATIENT CATARACT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-643-3561
Mailing Address - Street 1:100 S PARK DR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5918
Mailing Address - Country:US
Mailing Address - Phone:325-643-3561
Mailing Address - Fax:325-646-0670
Practice Address - Street 1:100 S PARK DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5918
Practice Address - Country:US
Practice Address - Phone:325-643-3561
Practice Address - Fax:325-646-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX490002105OtherPALMETTO GBA RR MEDICARE
TXHH1285OtherBLUE CROSS BLUE SHIELD
TX085890401Medicaid
TX451067Medicare ID - Type Unspecified