Provider Demographics
NPI:1891911350
Name:PROVIDENCE HEALTH SERVICES OF WACO
Entity Type:Organization
Organization Name:PROVIDENCE HEALTH SERVICES OF WACO
Other - Org Name:PROVIDENCE HEALTHCARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP - CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SADRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-751-4146
Mailing Address - Street 1:PO BOX 21567
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-1567
Mailing Address - Country:US
Mailing Address - Phone:254-751-4924
Mailing Address - Fax:
Practice Address - Street 1:6901 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7910
Practice Address - Country:US
Practice Address - Phone:254-751-4924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C83CMedicare ID - Type Unspecified