# PROVIDENCE HEALTH SERVICES OF WACO

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Medical Equipment
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073506457
- **Authorized official:** MR. KENT KEAHEY (CEO)
- **Authorized official phone:** (254) 751-4000

## Contact information

- **Practice address:** 540 MEADOWLAKE CTR, WACO, TX 76712-3981
- **Practice address phone:** (254) 741-2495
- **Practice address fax:** (254) 741-2496
- **Mailing address:** PO BOX 201157, DALLAS, TX 75320-1157
- **Mailing address phone:** (254) 741-2495
- **Mailing address fax:** (254) 741-2496

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |
| 335E00000X | Prosthetic/Orthotic Supplier | 000111 | TX | — |

## Other

- **Enumeration date:** 08/31/2005
- **Last updated:** 01/26/2012