Providence Health Services of Waco

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PROVIDENCE HEALTH SERVICES OF WACO

Doing business as

Providence Medical Equipment

Practice address

540 Meadowlake Ctr
Waco, TX 76712-3981

Phone

(254) 741-2495

Fax

(254) 741-2496

NPI assigned

Aug 31, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Kent Keahey

Title

Ceo

Phone

(254) 751-4000

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Providence Medical Equipment Doing business as

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Fish Pond Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Waco, TX
  • NPI 1477569069

  Member Of

  NPD member

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1073506457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 201157",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753201157",
            "telephone_number": "254-741-2495",
            "fax_number": "254-741-2496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 MEADOWLAKE CTR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767123981",
            "telephone_number": "254-741-2495",
            "fax_number": "254-741-2496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES OF WACO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-31",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "KEAHEY",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-751-4000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TX",
            "license": "000111",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087277201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "515091",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016043401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Medical Equipment",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providacare Medical Supply LTD
• Providence Health Alliance (Ascension Texas Imaging)
• Providence Health Alliance (Providence Family Health Clinic-Hillsboro)
• Providence Health Alliance
• Providence Health Services of Waco
• Providence Health Services of Waco (Emergency Room Physician Group)
• Providence Health Services of Waco (Providence Bariatric Center)
• Providence Health Services of Waco (DePaul Center)
• Providence Health Services of Waco (Providence Healthcare Network)
• Providence Health Services of Waco

• Durable Medical Equipment & Medical Supplies in Waco, TX
• Providers in Waco, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; 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.