Provider Demographics
NPI:1003016577
Name:BAYLOR PATHOLOGY CONSULTANTS
Entity Type:Organization
Organization Name:BAYLOR PATHOLOGY CONSULTANTS
Other - Org Name:BAYLOR COLLEGE OF MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-481-3544
Mailing Address - Street 1:PO BOX 4698
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4698
Mailing Address - Country:US
Mailing Address - Phone:713-481-3544
Mailing Address - Fax:
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2000
Practice Address - Country:US
Practice Address - Phone:409-983-4951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1061150OtherCLIA NUMBER