Providence Health Services of Waco

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PROVIDENCE HEALTH SERVICES OF WACO

Practice address

1130 N Loop 340
Lacy Lakeview, TX 76705

Phone

(254) 870-6480

Fax

(254) 870-6481

NPI assigned

Apr 14, 2017

Last updated

Nov 20, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Craig Cordola

Title

Ceo

Phone

(512) 324-1000

Specialties & licenses 1

Addresses

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

Locations

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

{
    "created_epoch": "1492128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511136000000",
    "number": "1184158362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 N LOOP 340",
            "city": "LACY LAKEVIEW",
            "state": "TX",
            "postal_code": "76705",
            "telephone_number": "254-870-6480",
            "fax_number": "254-870-6481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 N LOOP 340",
            "city": "LACY LAKEVIEW",
            "state": "TX",
            "postal_code": "76705",
            "telephone_number": "254-870-6480",
            "fax_number": "254-870-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES OF WACO",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-14",
        "last_updated": "2017-11-20",
        "status": "A",
        "authorized_official_last_name": "CORDOLA",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-324-1000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosa Linda Gomez
• Troy P Hudson, RPH
• Roshan Patel, MD
• Pharmacy Plus Inc (Pharmacy Plus #6)
• Providence Health Alliance (Ascension Medical Group Providence Urgent Care)
• Kathryn L. Sanson, RPH
• Onyedikachi Ugwu

• Durable Medical Equipment & Medical Supplies in Lacy Lakeview, TX
• Providers in Lacy Lakeview, 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 Nov 20, 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.