Provider Demographics
NPI:1770635864
Name:BAYLOR COLLEGE OF MEDICINE, MEDICAL GENETICS LABS
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE, MEDICAL GENETICS LABS
Other - Org Name:BAYLOR GENETICS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE LABORATORY DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-798-6555
Mailing Address - Street 1:PO BOX 4832
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4832
Mailing Address - Country:US
Mailing Address - Phone:713-798-3295
Mailing Address - Fax:713-798-4187
Practice Address - Street 1:1 BAYLOR PLZ
Practice Address - Street 2:MS: NAB 2015, ROOM 0280C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:713-798-3295
Practice Address - Fax:713-798-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D0660090OtherCLIA
0000CL0582OtherBLUE CROSS BLUE SHIELD
21093-14OtherCAP
TX2821183Medicaid
21093-14OtherCAP