Provider Demographics
NPI:1124492756
Name:BAYLOR COLLEGE OF MEDICINE
Entity type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:274-713-5289
Mailing Address - Street 1:12301 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-6207
Mailing Address - Country:US
Mailing Address - Phone:713-275-5000
Mailing Address - Fax:713-275-5107
Practice Address - Street 1:12301 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6207
Practice Address - Country:US
Practice Address - Phone:713-275-5000
Practice Address - Fax:713-275-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36111273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit