Organization
PROVIDENCE HEALTH SERVICES OF WACO
Active
Other names
Providence Medical Equipment
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENT KEAHEY (CEO)
(254) 751-4000
Entity
Organization
Contact information
Practice address
540 MEADOWLAKE CTR, WACO, TX 76712-3981
(254) 741-2495
(254) 741-2496
Mailing address
PO BOX 201157, DALLAS, TX 75320-1157
(254) 741-2495
(254) 741-2496
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
335E00000X
Prosthetic/Orthotic Supplier
000111
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016043401
—
TX
05
—
087277201
—
TX
01
—
515091
BLUE CROSS BLUE SHIELD
—
Enumeration date
08/31/2005
Last updated
01/26/2012
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