Provider Demographics
NPI:1902824659
Name:WACO HEMATOLOGY ONCOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:WACO HEMATOLOGY ONCOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-741-1860
Mailing Address - Street 1:2911 HERRING AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3245
Mailing Address - Country:US
Mailing Address - Phone:254-741-1860
Mailing Address - Fax:
Practice Address - Street 1:2911 HERRING AVE
Practice Address - Street 2:STE 209
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3245
Practice Address - Country:US
Practice Address - Phone:254-741-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A34WMedicare ID - Type Unspecified