Healthcare Provider Details

I. General information

NPI: 1891726550
Provider Name (Legal Business Name): BAY AREA HOUSTON ENDOSCOPY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 MEDICAL CENTER BLVD SUITE 1200
WEBSTER TX
77598-4052
US

IV. Provider business mailing address

1015 MEDICAL CENTER BLVD SUITE 1200
WEBSTER TX
77598-4052
US

V. Phone/Fax

Practice location:
  • Phone: 282-338-2861
  • Fax: 281-554-2035
Mailing address:
  • Phone: 282-338-2861
  • Fax: 281-554-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN C MARCUM
Title or Position: PRESIDENT
Credential: MD
Phone: 281-338-2861