Provider Demographics
NPI:1548453665
Name:BAYLOR COLLEGE OF MEDICINE RADIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:BAYLOR COLLEGE OF MEDICINE RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-481-3533
Mailing Address - Street 1:PO BOX 3119
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3119
Mailing Address - Country:US
Mailing Address - Phone:713-481-3594
Mailing Address - Fax:713-481-3513
Practice Address - Street 1:4600 E SAM HOUSTON PKWY S
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3948
Practice Address - Country:US
Practice Address - Phone:713-481-3594
Practice Address - Fax:713-481-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191613201Medicaid
TX0088QCOtherBCBSTX
TX212116201Medicaid
TX191613201Medicaid
TX0A6221Medicare PIN