Provider Demographics
NPI:1497970867
Name:BAY AREA HOUSTON GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:BAY AREA HOUSTON GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-338-2861
Mailing Address - Street 1:1015 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4052
Mailing Address - Country:US
Mailing Address - Phone:281-338-2861
Mailing Address - Fax:281-554-2035
Practice Address - Street 1:1015 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 1400
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4052
Practice Address - Country:US
Practice Address - Phone:281-338-2861
Practice Address - Fax:281-554-2035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180767901Medicaid
TX180767901Medicaid