1225072291 NPI number — BAYLOR COLLEGE OF MEDICINE

Table of content: (NPI 1225072291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225072291 NPI number — BAYLOR COLLEGE OF MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYLOR COLLEGE OF MEDICINE
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:
DEPARTMENT OF SURGERY
Provider Other Organization Name Type Code:
5
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:
1225072291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 E GREENWAY PLZ
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77046-0297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-798-1750
Provider Business Mailing Address Fax Number:
713-798-1144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6620 MAIN ST
Provider Second Line Business Practice Location Address:
STE 1475
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-798-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLISON
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
713-798-1746

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 094973702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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