Provider Demographics
NPI:1083633143
Name:BAYLOR ALL SAINTS MEDICAL CENTER
Entity Type:Organization
Organization Name:BAYLOR ALL SAINTS MEDICAL CENTER
Other - Org Name:BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER - FORT WORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-927-6224
Mailing Address - Street 1:PO BOX 848108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8108
Mailing Address - Country:US
Mailing Address - Phone:214-820-6710
Mailing Address - Fax:214-820-7950
Practice Address - Street 1:1400 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4110
Practice Address - Country:US
Practice Address - Phone:817-922-1957
Practice Address - Fax:817-927-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0003632085R0202X, 363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135036506Medicaid
TXCG5772OtherRAILROAD
TX135036506Medicaid