Provider Demographics
NPI:1518245448
Name:BAYLOR COLLEGE OF MEDICINE
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-798-6362
Mailing Address - Street 1:ONE BAYLOR PLAZA
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY BCM360
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3498
Mailing Address - Country:US
Mailing Address - Phone:713-798-6362
Mailing Address - Fax:
Practice Address - Street 1:ONE BAYLOR PLAZA
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY BCM360
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3498
Practice Address - Country:US
Practice Address - Phone:713-798-6362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20040820261QM2500X, 261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty