Provider Demographics
NPI:1336551761
Name:BAYLOR COLLEGE OF MEDICINE TEN HEALTH CLINIC
Entity Type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE TEN HEALTH CLINIC
Other - Org Name:BAYLOR TEEN HEALTH CLINIC- STERLING HIGH SCHOOL
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 1:8111 LAWN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-6323
Mailing Address - Country:US
Mailing Address - Phone:281-850-2995
Mailing Address - Fax:281-445-4796
Practice Address - Street 1:11625 MARTINDALE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77048-2005
Practice Address - Country:US
Practice Address - Phone:281-850-2995
Practice Address - Fax:281-445-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility