Provider Demographics
NPI:1871525683
Name:CITY OF WACO
Entity type:Organization
Organization Name:CITY OF WACO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-750-5459
Mailing Address - Street 1:225 WEST WACO DRIVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76707-3897
Mailing Address - Country:US
Mailing Address - Phone:254-750-5409
Mailing Address - Fax:254-750-5455
Practice Address - Street 1:225 WEST WACO DRIVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-3897
Practice Address - Country:US
Practice Address - Phone:254-750-5409
Practice Address - Fax:254-750-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223D0001X, 261QP0905X
TXF7262261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or LocalGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138707806Medicaid
TX138707810Medicaid
TX138707803Medicaid
TX138707804Medicaid
TX138707810Medicaid
TXPH0008Medicare PIN