MEDICARE: BAYLOR RESEARCH INSTITUTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		TX

General Provider Information

NPI Number	:	1790836419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYLOR RESEARCH INSTITUTE

Provider Business Mailing Address
First Line	:	3310 LIVE OAK ST
Second Line	:	SUITE 105
City	:	DALLAS
State	:	TX
Zip	:	75204-6153
Country	:	US
Telephone Number	:	214-820-2687
Fax Number	:	214-820-4952

Provider Business Practice Location Address
First Line	:	3812 ELM ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75226-1216
Country	:	US
Telephone Number	:	214-820-4533
Fax Number	:	214-820-4952

Authorized Official
Title or Position	:	VICE PRESIDENT FINANCE
Name	:	MR. MICHAEL ANDERS MATHISEN
Credential	:
Telephone Number	:	214-820-4992

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

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