1427311042 NPI number — BAYLOR FAMILY MEDICINE CLINIC

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 1427311042 NPI number — BAYLOR FAMILY MEDICINE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYLOR FAMILY MEDICINE CLINIC
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:
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:
1427311042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 CLARA BARTON BLVD
Provider Second Line Business Mailing Address:
# 340
Provider Business Mailing Address City Name:
GARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75042-5738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-272-6554
Provider Business Mailing Address Fax Number:
972-272-5969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 CLARA BARTON
Provider Second Line Business Practice Location Address:
340
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-272-6554
Provider Business Practice Location Address Fax Number:
972-272-5969
Provider Enumeration Date:
06/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TINGLE
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
972-272-6554

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X , with the licence number:  33763 , 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)





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