Organization
CENTRAL TEXAS UROLOGIC ASSOCIATES, P.A.
Active
Other names
CENTRAL TEXAS UROLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY GILLILAND (ADMINISTRATOR)
(254) 741-6113
Entity
Organization
Contact information
Practice address
601 W STATE HWY 6, 105, WACO, TX 76710-5575
(254) 741-6113
(254) 741-6629
Mailing address
601 W STATE HIGHWAY 6, 105, WACO, TX 76710-5591
(254) 741-6113
(254) 741-6629
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G20L
MEDICARE GROUP
TX
05
—
082657002
—
TX
Enumeration date
08/17/2006
Last updated
09/18/2013
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