Provider Demographics
NPI:1427311042
Name:BAYLOR FAMILY MEDICINE CLINIC
Entity type:Organization
Organization Name:BAYLOR FAMILY MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-272-6554
Mailing Address - Street 1:601 CLARA BARTON BLVD
Mailing Address - Street 2:# 340
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5738
Mailing Address - Country:US
Mailing Address - Phone:972-272-6554
Mailing Address - Fax:972-272-5969
Practice Address - Street 1:601 CLARA BARTON
Practice Address - Street 2:340
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042
Practice Address - Country:US
Practice Address - Phone:972-272-6554
Practice Address - Fax:972-272-5969
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33763171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty