NPIMap

Organization Active NPI

Providence Health Services of Waco

  • Psychiatric Hospital
  • Waco, TX
National Provider Identifier
1033436407
Registry record updated Nov 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
000040 Issued in TX
Legal business name
PROVIDENCE HEALTH SERVICES OF WACO
Practice address
301 Londonderry Dr
Waco, TX 76712-7915
Phone
(254) 751-4146
Fax
(254) 751-4283
NPI assigned
Apr 26, 2010
Last updated
Nov 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Craig Cordola
Title
Ceo
Phone
(512) 325-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 000040 TX Primary

Addresses

Primary practice location

301 Londonderry Dr
Waco, TX 76712-7915

Mailing address

PO Box 2589
Waco, TX 76702-2589
Phone (254) 751-4146

National Provider Directory

National Provider Directory
Tax ID family
Providence Health Services of Waco5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 Londonderry Dr
Waco, TX 76712
Phone (254) 751-4880

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511222400000",
    "number": "1033436407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2589",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767022589",
            "telephone_number": "254-751-4146",
            "fax_number": "254-751-4283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 LONDONDERRY DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127915",
            "telephone_number": "254-751-4146",
            "fax_number": "254-751-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES OF WACO",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-26",
        "last_updated": "2017-11-21",
        "status": "A",
        "authorized_official_last_name": "CORDOLA",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-325-1000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "TX",
            "license": "000040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.