Provider Demographics
NPI:1730406265
Name:ASCENSION PROVIDENCE
Entity type:Organization
Organization Name:ASCENSION PROVIDENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-751-4766
Mailing Address - Street 1:PO BOX 206121
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-6121
Mailing Address - Country:US
Mailing Address - Phone:254-751-4146
Mailing Address - Fax:254-751-4283
Practice Address - Street 1:301 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7915
Practice Address - Country:US
Practice Address - Phone:254-751-4146
Practice Address - Fax:254-751-4283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION PROVIDENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-23
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45S042Medicare Oscar/Certification