Provider Demographics
NPI:1669719282
Name:BAYLOR COMMUNITY CARE- CITYSQUARE
Entity type:Organization
Organization Name:BAYLOR COMMUNITY CARE- CITYSQUARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-421-1783
Mailing Address - Street 1:2835 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-1647
Mailing Address - Country:US
Mailing Address - Phone:214-421-1783
Mailing Address - Fax:214-421-8224
Practice Address - Street 1:2835 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-1647
Practice Address - Country:US
Practice Address - Phone:214-421-1783
Practice Address - Fax:214-421-8224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07675261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care