Provider Demographics
NPI:1437496189
Name:BAY AREA COLORECTAL SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:BAY AREA COLORECTAL SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-766-0741
Mailing Address - Street 1:7111 MEDICAL CENTER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2666
Mailing Address - Country:US
Mailing Address - Phone:409-766-0741
Mailing Address - Fax:877-664-9073
Practice Address - Street 1:7111 MEDICAL CENTER DR
Practice Address - Street 2:STE 100
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2666
Practice Address - Country:US
Practice Address - Phone:832-738-1836
Practice Address - Fax:281-678-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1500208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R518Medicare PIN
8G6730Medicare PIN
C15830Medicare PIN
TXP00393666Medicare PIN