Provider Demographics
NPI:1669465068
Name:BAY AREA ENDOSCOPY CENTER, LC
Entity type:Organization
Organization Name:BAY AREA ENDOSCOPY CENTER, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATARAJAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP, FACG
Authorized Official - Phone:281-481-9400
Mailing Address - Street 1:444 FM 1959 RD
Mailing Address - Street 2:STE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5416
Mailing Address - Country:US
Mailing Address - Phone:281-481-9400
Mailing Address - Fax:
Practice Address - Street 1:444 FM 1959 RD
Practice Address - Street 2:STE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-5416
Practice Address - Country:US
Practice Address - Phone:281-481-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000328261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1379OtherBCBS
TX085959701Medicaid
TX490003277OtherRAILROAD MEDICARE
TX490003277OtherRAILROAD MEDICARE