Organization
PROVIDENCE HEALTH SERVICES OF WACO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG CORDOLA (CEO)
(512) 324-1000
Entity
Organization
Contact information
Practice address
1130 N LOOP 340, LACY LAKEVIEW, TX 76705
(254) 870-6480
(254) 870-6481
Mailing address
1130 N LOOP 340, LACY LAKEVIEW, TX 76705
(254) 870-6480
(254) 870-6481
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/14/2017
Last updated
11/20/2017
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