Provider Demographics
NPI:1104867175
Name:BAYLOR COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE
Other - Org Name:BAYLOR INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARDS
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:713-798-1746
Mailing Address - Street 1:2 E GREENWAY PLZ
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0297
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:6620 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2305
Practice Address - Country:US
Practice Address - Phone:713-798-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCI7180OtherRR MEDICARE
TX135252804Medicaid
TX00QF35Medicare PIN