| Community Clinic at Mcc | |
|
4601 N 19th St Waco TX 76708-1261 | |
| (254) 313-5800 | |
| (254) 313-5849 |
| Full Name | Community Clinic at Mcc |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 4601 N 19th St, Waco, Texas |
| Authorized Official Name and Position | Annette Ballew (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2543134282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Clinic at Mcc 1600 Providence Dr Waco TX 76707-2261 Ph: (254) 313-4200 | Community Clinic at Mcc 4601 N 19th St Waco TX 76708-1261 Ph: (254) 313-5800 |
| NPI Number | 1942584255 |
|---|---|
| Provider Enumeration Date | 10/05/2011 |
| Last Update Date | 07/28/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942584255 | NPI | - | NPPES |
| 068160 | Other | TX | UNIFORM DATA SET |
| FQ0000676 | Medicaid | TX | |
| 092957204 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| 207Q00000X | Family Medicine | (NU) | Secondary |
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