1942665955 NPI number — BAYLOR LEE HIGH TEEN HEALTH

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 1942665955 NPI number — BAYLOR LEE HIGH TEEN HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYLOR LEE HIGH TEEN HEALTH
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 CLINIC-LEE
Provider Other Organization Name Type Code:
3
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:
1942665955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1504 TAUB LOOP # 1A29
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:
77030-1608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-440-7313
Provider Business Mailing Address Fax Number:
713-440-9238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6529 BEVERLYHILL 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:
77057-6406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-924-1600
Provider Business Practice Location Address Fax Number:
713-440-9238
Provider Enumeration Date:
12/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SALAZAR
Authorized Official First Name:
CAROLINA
Authorized Official Middle Name:
Authorized Official Title or Position:
R.N.
Authorized Official Telephone Number:
713-440-7313

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 16957 , 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: 2155969 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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