NPIMap

Organization Active NPI

Heart of Texas Community Health Center, Inc

Doing business as West Waco Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Waco, TX
National Provider Identifier
1730409269
Registry record updated Jul 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC
Doing business as
West Waco Community Clinic
Practice address
600 W State Highway 6
Waco, TX 76712-3977
Phone
(254) 313-6500
Fax
(254) 313-6599
NPI assigned
Jun 7, 2010
Last updated
Jul 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2017

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

Authorized official

Name
Mrs. Annette Ballew, CPA
Title
Cfo
Phone
(254) 313-4282

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

600 W State Highway 6
Waco, TX 76712-3977

Mailing address

1600 Providence Dr
Waco, TX 76707-2261
Phone (254) 313-4200

Other identifiers 3

IdentifierTypeStateIssuer
351323601MedicaidTX
FQ0000676OtherTXMEDICAID
092957202MedicaidTX

Other names 1

  • West Waco Community Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080205000590 TX Part A Provider - Federally Qualified Health Center (FQHC) 1153370242 1 other NPI on this enrollment
Practice locations: Waco, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730409269. Details of each certification follow.

Federally qualified health center certification: CCN 671874

Legal name
HEART OF TEXAS COMMUNITY HEALTH CENTER, INC.
Doing business as
WACO FAMILY MEDICINE - WEST WACO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 24, 2008
Last certification
Mar 24, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1998 in TX
Enrollment address
600 W State Highway 6
Waco, TX 76712-3977

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 16

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1061102Heart of Texas Community Health Center Inc600 West State Hwy 6, Waco, TX 76712Provider-performed microscopyNov 8, 2026

National Provider Directory

National Provider Directory
Tax ID family
Heart of TX Comm HLTH Ctr25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

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

View all 24

Locations

600 W State Highway 6
Waco, TX 76712
Phone (254) 313-6700

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristen Padilla-Manor Individual Corporate Director Jun 1, 2019
Donald M Hardin Individual Corporate Officer May 10, 2021
Joshua Lee Caballero Individual Corporate Director Oct 24, 2022
Mildred Watley Individual Corporate Director Jul 19, 2021
Malcolm Duncan Individual Corporate Director Mar 23, 2020
Sherry Williams Individual Corporate Director Apr 22, 2019
Matthew Polk Individual Corporate Officer Oct 1, 2020
Gloria Guerra Individual Corporate Director Jun 1, 2019
George Johnson Individual Corporate DirectorDirector Nov 13, 2017
Tashita Bibles Individual Corporate Director Jul 19, 2021
William Clifton Individual Corporate Director Nov 26, 2007
Delia Anzaldua-Rivera Individual Corporate DirectorDirector Dec 12, 2016
Annette Ballew Individual Corporate OfficerCfo Jan 15, 1998
W-2 Managing Employee Jun 30, 1998
Marc Barrett Individual Corporate Director Mar 23, 2020
Dale Barron Individual Corporate OfficerChief Advancement Officer Jun 26, 2017
Luis Arroyo Individual Corporate Officer Feb 24, 2020
Mark Hobbs Individual Corporate Director Apr 22, 2019
Jackson O Griggs Individual Corporate Officer Feb 25, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Waco Family Medicine - Madison CooperWaco, TX, CCN 671013 Federally qualified health center Operational/Managerial Control (100%) Jun 1, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501200000000",
    "number": "1730409269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 PROVIDENCE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767072261",
            "telephone_number": "254-313-4200",
            "fax_number": "254-313-4326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W STATE HIGHWAY 6",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767123977",
            "telephone_number": "254-313-6500",
            "fax_number": "254-313-6599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART OF TEXAS COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-07",
        "last_updated": "2017-07-28",
        "status": "A",
        "authorized_official_last_name": "BALLEW",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "254-313-4282",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "351323601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "FQ0000676",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092957202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Waco Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.