1669711404 NPI number — BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC

Table of content: (NPI 1669711404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669711404 NPI number — BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYLOR COLLEGE OF MEDICINE TEEN HEALTH 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:
BAYLOR TEEN HEALTH CLINIC - WORTHING HIGH SCHOOL
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:
1669711404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8111 LAWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77088-6323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-850-2995
Provider Business Mailing Address Fax Number:
281-445-4796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9215 SCOTT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77051-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-440-7313
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PROFESSOR DIRECTOR
Authorized Official Telephone Number:
713-873-3601

Provider Taxonomy Codes

  • Taxonomy code: 261QA0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1306975107 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1437288180 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1295815637 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1750461182 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1306975081 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1396874293 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1457480212 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1992834790 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1184753931 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1720327182 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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