Provider Demographics
NPI:1457671190
Name:BAYLOR COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, FACULTY GROUP PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-798-2406
Mailing Address - Street 1:7200B CAMBRIDGE ST
Mailing Address - Street 2:E1.108, MS BCM 631
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4202
Mailing Address - Country:US
Mailing Address - Phone:713-798-2020
Mailing Address - Fax:713-798-2025
Practice Address - Street 1:7200B CAMBRIDGE ST
Practice Address - Street 2:E1.108, MS BCM 631
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4202
Practice Address - Country:US
Practice Address - Phone:713-798-2020
Practice Address - Fax:713-798-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies