Provider Demographics
NPI:1134485659
Name:BAYLOR COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE
Other - Org Name:JOHN WELSH CARDIOVASCULAR DIAGNOSTIC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT PROFESSOR/LAB DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YUXIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, FACMG
Authorized Official - Phone:832-824-4155
Mailing Address - Street 1:1102 BATES AVE STE 430.09
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2620
Mailing Address - Country:US
Mailing Address - Phone:832-824-4152
Mailing Address - Fax:
Practice Address - Street 1:1102 BATES AVE STE 430.09
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2620
Practice Address - Country:US
Practice Address - Phone:832-824-4152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory