Provider Demographics
NPI:1619457157
Name:BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC
Other - Org Name:MILBY HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABACAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-873-7306
Mailing Address - Street 1:1601 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77012-3721
Mailing Address - Country:US
Mailing Address - Phone:713-440-7313
Mailing Address - Fax:
Practice Address - Street 1:1601 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77012-3721
Practice Address - Country:US
Practice Address - Phone:713-440-7313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility