=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659692275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAYLOR COLLEGE OF MEDICINE TEEN HEALTH CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2010
-----------------------------------------------------
Last Update Date | 06/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8111 LAWN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77088-6374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-820-2995
-----------------------------------------------------
Fax | 281-445-4796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8501 HOWARD DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77017-3829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-495-6971
-----------------------------------------------------
Fax | 832-519-1799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROFESSOR DIRECTOR
-----------------------------------------------------
Name | PROF. PEGGY B SMITH
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 713-873-3601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0005X
-----------------------------------------------------
Taxonomy Name | Ambulatory Family Planning Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QF0050X
-----------------------------------------------------
Taxonomy Name | Non-Surgical Family Planning Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------