Organization
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Active
Other names
Elm Avenue Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE BALLEW CPA (CFO)
(254) 313-4282
Entity
Organization
Contact information
Practice address
609 ELM ST, WACO, TX 76704-2516
(254) 313-6900
(254) 313-6959
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
01
—
06816A
MEDICARE SITE ID
TX
05
—
092957202
—
TX
05
—
092957203
—
TX
05
—
286210401
—
TX
05
—
FQ0000676
—
TX
Enumeration date
02/25/2008
Last updated
07/28/2017
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