Organization
PROVIDENCE HEALTH ALLIANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAYTON CARSNER (VP/COO)
(512) 324-5846
Entity
Organization
Contact information
Practice address
6901 MEDICAL PKWY, WACO, TX 76712-7910
(254) 751-4061
(254) 537-6869
Mailing address
1345 PHILOMENA ST, SUITE 410.3, AUSTIN, TX 78723
(800) 566-5050
(254) 537-6869
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00N59X
BCBS OF TEXAS
TX
05
—
084249401
—
TX
05
—
092245202
—
TX
Enumeration date
08/31/2006
Last updated
08/31/2023
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