Provider Demographics
NPI:1881808566
Name:WACO INFECTIOUS DISEASE ASSOCIATES
Entity type:Organization
Organization Name:WACO INFECTIOUS DISEASE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:FARLEY
Authorized Official - Last Name:VERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-295-4355
Mailing Address - Street 1:7030 NEW SANGER AVE SUITE 202
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:281-295-4208
Mailing Address - Fax:281-295-4065
Practice Address - Street 1:7030 NEW SANGER RD STE 202
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3991
Practice Address - Country:US
Practice Address - Phone:281-295-4208
Practice Address - Fax:281-295-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094993501Medicaid
TX094993501Medicaid