Provider Demographics
NPI:1619683539
Name:BAYTOWN FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:BAYTOWN FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHINA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-837-0846
Mailing Address - Street 1:1618 W BAKER RD STE B
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2280
Mailing Address - Country:US
Mailing Address - Phone:281-837-0846
Mailing Address - Fax:281-837-6186
Practice Address - Street 1:1618 W BAKER RD STE B
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2280
Practice Address - Country:US
Practice Address - Phone:281-837-0846
Practice Address - Fax:281-837-6186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111878801Medicaid