Provider Demographics
NPI:1942584255
Name:HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Other - Org Name:COMMUNITY CLINIC AT MCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLEW
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:254-313-4282
Mailing Address - Street 1:1600 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-2261
Mailing Address - Country:US
Mailing Address - Phone:254-313-4200
Mailing Address - Fax:254-313-4326
Practice Address - Street 1:4601 N 19TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-1261
Practice Address - Country:US
Practice Address - Phone:254-313-5800
Practice Address - Fax:254-313-5849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-05
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX068160OtherUNIFORM DATA SET
TXFQ0000676Medicaid
TX092957204Medicaid
TXFQ0000676Medicaid
TX00145KMedicare Oscar/Certification