Providence Health Alliance

NPI #1063027464 in Waco, Texas

Provider Information

NPI Number: 1063027464
Entity Type: Organization
Organization Name: Providence Health Alliance
Primary Specialty: Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Enumeration Date: Sep 11, 2020
Last Updated: Sep 11, 2020

Practice Location

Address: 1130 N LOOP 340
City: Waco
State: Texas
ZIP Code: 76705
Phone: (254) 537-6880

Authorized Official

Name: CLAYTON CARSNER
Title: VP/COO
Phone: (512) 324-5846

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	335V00000X	Primary

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