Provider Demographics
NPI:1093880437
Name:BAYLOR COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE
Other - Org Name:BAYLOR COLLEGE OF MEDICINE DEPT OF OTOLARYNGOLOGY HEAD AND NECK CONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-798-8291
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1701
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-798-5900
Mailing Address - Fax:713-798-5294
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1701
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-798-5900
Practice Address - Fax:713-798-5294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYLOR COLLEGE OF MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000B84S4Medicaid
TXZ000B84S4Medicaid