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General NPI Number Information
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NPI Number | 1669719282
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Entity Type | Organization
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Legal Business Name | BAYLOR COMMUNITY CARE- CITYSQUARE
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 2835 GRAND AVE
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City | DALLAS
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State | TX
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Zip | 75215-1647
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Country | US
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Telephone | 214-421-1783
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Fax | 214-421-8224
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Provider Business Mailing Address
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Address Line | 2835 GRAND AVE
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City | DALLAS
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State | TX
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Zip | 75215-1647
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Country | US
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Telephone | 214-421-1783
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Fax | 214-421-8224
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | LEIGH ALLEN
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Credential |
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Telephone | 214-421-1783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 07675
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License Number State | TX
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