Provider Demographics
NPI:1326201476
Name:BAYLOR COLLEGE OF MEDICINE AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, AMBULATORY SURGERY CENTER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-798-2246
Mailing Address - Street 1:1977 BUTLER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4101
Mailing Address - Country:US
Mailing Address - Phone:713-798-2246
Mailing Address - Fax:713-798-3383
Practice Address - Street 1:1977 BUTLER BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-2246
Practice Address - Fax:713-798-3383
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAYLOR COLLEGE OF MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-09
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXASC388Medicare PIN