Organization
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
Active
Other names
South 18th Street Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE BALLEW CPA (CFO)
(254) 313-4282
Entity
Organization
Contact information
Practice address
1800 GURLEY LN, WACO, TX 76706-4025
(254) 313-6000
(254) 313-6099
Mailing address
1600 PROVIDENCE DR, WACO, TX 76707-2261
(254) 313-4200
(254) 313-4326
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285245101
—
TX
01
—
FQ0000676
MEDICAID
TX
Enumeration date
06/15/2010
Last updated
07/28/2017
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