Provider Demographics
NPI:1215987490
Name:WACO GASTROENTEROLOGY ASSOCIATES
Entity type:Organization
Organization Name:WACO GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-537-0911
Mailing Address - Street 1:364 RICHLAND WEST CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7919
Mailing Address - Country:US
Mailing Address - Phone:254-537-0911
Mailing Address - Fax:254-537-0313
Practice Address - Street 1:364 RICHLAND WEST CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-537-0911
Practice Address - Fax:254-537-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081724901Medicaid
TX00B77SMedicare PIN