Provider Demographics
NPI:1962592113
Name:HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA
Entity type:Organization
Organization Name:HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-643-3300
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-0520
Mailing Address - Country:US
Mailing Address - Phone:325-643-3300
Mailing Address - Fax:325-641-8714
Practice Address - Street 1:109 NORTH 2ND STREET
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TX
Practice Address - Zip Code:76443-2401
Practice Address - Country:US
Practice Address - Phone:254-725-7106
Practice Address - Fax:254-725-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673901Medicare Oscar/Certification