Organization
PROVIDENCE HEALTH SERVICES OF WACO, INC
Active
Organization
PROVIDENCE HEALTH SERVICES OF WACO, INC
Active
Parent organization
PROVIDENCE HEALTH SERVICES OF WACO, INC
Other names
Providence Medical Equipment Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH SERVICES OF WACO, INC
Authorized official
MR. ODIS W. NICHOLS JR. (COO)
(254) 751-4000
Entity
Organization
Contact information
Practice address
6600 FISH POND ROAD, SUITE 104, WACO, TX 76710
(254) 741-2495
Mailing address
540 MEADOWLAKE CENTER, WACO, TX 76712
(254) 741-2495
(254) 741-2496
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0160434-01
—
TX
Enumeration date
03/16/2009
Last updated
08/04/2010
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