Provider Demographics
NPI:1679759245
Name:BAYCENTER FAMILY PHYSICIAN, P.A.
Entity Type:Organization
Organization Name:BAYCENTER FAMILY PHYSICIAN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROCKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-991-0444
Mailing Address - Street 1:4343 FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3305
Mailing Address - Country:US
Mailing Address - Phone:281-991-0444
Mailing Address - Fax:
Practice Address - Street 1:4343 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3305
Practice Address - Country:US
Practice Address - Phone:281-991-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3839305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080180411OtherRR MEDICARE
TX8B3010OtherBC/BS
TX145830901Medicaid
TX145830901Medicaid