1093883076 NPI number — BAYLOR SCOTT & WHITE HEALTH ENTERPRISES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093883076 NPI number — BAYLOR SCOTT & WHITE HEALTH ENTERPRISES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYLOR SCOTT & WHITE HEALTH ENTERPRISES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093883076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 847670
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-5765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-953-7777
Provider Business Mailing Address Fax Number:
254-953-7775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 CROSS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76543-5256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-953-7777
Provider Business Practice Location Address Fax Number:
254-953-7775
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-865-3669

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  29823 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2151705 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 469872 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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