Provider Demographics
NPI:1497843700
Name:BAYLOR COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE
Other - Org Name:HCHD ANESTHESIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-798-1710
Mailing Address - Street 1:2 GREENWAY PLAZA
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046
Mailing Address - Country:US
Mailing Address - Phone:713-798-1835
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:DEPT. OF ANESTHESIOLOGY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-873-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D95NMedicare PIN