Active NPI
Providence Health Services of Waco, Inc
- Prosthetic/Orthotic Supplier
- Waco, TX
National Provider Identifier
1902047285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetic/Orthotic Supplier
- Legal business name
- PROVIDENCE HEALTH SERVICES OF WACO, INC
- Doing business as
- Providence Medical Equipment Services
- Practice address
- 6600 Fish Pond Road
Suite 104
Waco, TX 76710 - Phone
- (254) 741-2495
- NPI assigned
- Mar 16, 2009
- Organization subpart
- Yes
- Parent organization
- PROVIDENCE HEALTH SERVICES OF WACO, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Odis W. Nichols Jr.
- Title
- Coo
- Phone
- (254) 751-4000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthetic/Orthotic Supplier | 335E00000X | Primary |
Addresses
Primary practice location
6600 Fish Pond Road
Suite 104
Waco, TX 76710
Mailing address
540 Meadowlake Center
Waco, TX 76712
Phone (254) 741-2495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0160434-01 | Medicaid | TX |
Other names 1
- Providence Medical Equipment Services
National Provider Directory
National Provider Directory- Part of
- Prov HLTH Services of Waco
Locations
540 Meadowlake Ctr
Waco, TX 76712
Phone (254) 741-2495
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237161600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1280880000000",
"number": "1902047285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "540 MEADOWLAKE CENTER",
"city": "WACO",
"state": "TX",
"postal_code": "76712",
"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": "6600 FISH POND ROAD",
"address_2": "SUITE 104",
"city": "WACO",
"state": "TX",
"postal_code": "76710",
"telephone_number": "254-741-2495"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVIDENCE HEALTH SERVICES OF WACO, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PROVIDENCE HEALTH SERVICES OF WACO, INC",
"enumeration_date": "2009-03-16",
"last_updated": "2010-08-04",
"status": "A",
"authorized_official_last_name": "NICHOLS",
"authorized_official_first_name": "ODIS",
"authorized_official_middle_name": "W.",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "254-751-4000",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "335E00000X",
"taxonomy_group": "",
"desc": "Prosthetic/Orthotic Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0160434-01",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Providence Medical Equipment Services",
"code": "3",
"type": "Doing Business As"
}
]
}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 Aug 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.