Provider Demographics
NPI:1881107324
Name:BAYLOR COLLEG OF MEDICINE TEEN HEALTH CLINIC
Entity type:Organization
Organization Name:BAYLOR COLLEG OF MEDICINE TEEN HEALTH CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PROGRAM DIRECTOR
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:281-847-9970
Mailing Address - Fax:
Practice Address - Street 1:1700 DUMBLE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3139
Practice Address - Country:US
Practice Address - Phone:713-924-1173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility