Provider Demographics
NPI:1437288180
Name:BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:BRZESZKIEWICZ
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-873-3601
Mailing Address - Street 1:1504 TAUB LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1608
Mailing Address - Country:US
Mailing Address - Phone:713-873-3601
Mailing Address - Fax:713-873-3610
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-3601
Practice Address - Fax:713-873-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084887101OtherTPI NUMBER