=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669465068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY AREA ENDOSCOPY CENTER, LC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 11/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 444 FM 1959 RD STE B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77034-5416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-481-9400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 444 FM 1959 RD STE B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77034-5416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-481-9400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. NATARAJAN S BALA
-----------------------------------------------------
Credential | MD, FACP, FACG
-----------------------------------------------------
Telephone | 281-481-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0800X
-----------------------------------------------------
Taxonomy Name | Endoscopy Clinic/Center
-----------------------------------------------------
License Number | 000328
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------