Provider Demographics
NPI:1164683298
Name:DAVE E WEBSTER D.O., PA
Entity type:Organization
Organization Name:DAVE E WEBSTER D.O., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-690-8887
Mailing Address - Street 1:PO BOX 2909
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-0909
Mailing Address - Country:US
Mailing Address - Phone:254-690-8887
Mailing Address - Fax:254-690-6696
Practice Address - Street 1:5610 E CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 1
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5519
Practice Address - Country:US
Practice Address - Phone:254-690-8887
Practice Address - Fax:264-690-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5982261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1364444006Medicaid
TX1364444006Medicaid
TX00Z521Medicare PIN