Provider Demographics
NPI:1790836419
Name:BAYLOR RESEARCH INSTITUTE
Entity Type:Organization
Organization Name:BAYLOR RESEARCH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDERS
Authorized Official - Last Name:MATHISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-820-4992
Mailing Address - Street 1:3310 LIVE OAK ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6153
Mailing Address - Country:US
Mailing Address - Phone:214-820-2687
Mailing Address - Fax:214-820-4952
Practice Address - Street 1:3812 ELM ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1216
Practice Address - Country:US
Practice Address - Phone:214-820-4533
Practice Address - Fax:214-820-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory