Provider Demographics
NPI:1386839017
Name:BAYLOR COLLEGE OF MEDICINE, DEPARTMENT OF ORTHOPEDIC SURGERY
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE, DEPARTMENT OF ORTHOPEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HOLTE
Authorized Official - Last Name:HEGGENESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-986-5730
Mailing Address - Street 1:PO BOX 203146
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-3146
Mailing Address - Country:US
Mailing Address - Phone:713-986-6000
Mailing Address - Fax:713-986-6001
Practice Address - Street 1:6620 MAIN STREET
Practice Address - Street 2:13TH FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2348
Practice Address - Country:US
Practice Address - Phone:713-986-6000
Practice Address - Fax:713-986-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7753207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093855703Medicaid
TX093855703Medicaid
TX00L95GMedicare PIN