Provider Demographics
NPI:1629104039
Name:BAYLOR SCOTT & WHITE HEALTH ENTERPRISES, INC.
Entity Type:Organization
Organization Name:BAYLOR SCOTT & WHITE HEALTH ENTERPRISES, INC.
Other - Org Name:BAYLOR SCOTT & WHITE PHARMACY #101
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-865-3669
Mailing Address - Street 1:PO BOX 847670
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7670
Mailing Address - Country:US
Mailing Address - Phone:214-820-3451
Mailing Address - Fax:214-820-4088
Practice Address - Street 1:3600 GASTON AVE STE 109
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1801
Practice Address - Country:US
Practice Address - Phone:214-820-3451
Practice Address - Fax:214-820-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX218673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2095103OtherPK
TX470147Medicaid
1005690002Medicare NSC
TX144355Medicaid