Provider Demographics
NPI:1659692275
Name:BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC
Other - Org Name:BAYLOR/TEEN HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PROFESSOR DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-873-3601
Mailing Address - Street 1:8501 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-3829
Mailing Address - Country:US
Mailing Address - Phone:713-495-6971
Mailing Address - Fax:832-519-1799
Practice Address - Street 1:8111 LAWN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-6374
Practice Address - Country:US
Practice Address - Phone:281-820-2995
Practice Address - Fax:281-445-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
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TX1306975081OtherNPI NUMBER
TX1437288180OtherNPI NUMBER
TX1992834790OtherNPI NUMBER