Basic Information
Provider Information
NPI: 1053319798
EntityType: 2
ReplacementNPI:  
OrganizationName: BAYLOR SPECIALTY HEALTH CENTERS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: OUR CHILDREN'S HOUSE AT BAYLOR
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 847137
Address2:  
City: DALLAS
State: TX
PostalCode: 752847137
CountryCode: US
TelephoneNumber: 2148206710
FaxNumber: 2148207950
Practice Location
Address1: 3301 SWISS AVE
Address2:  
City: DALLAS
State: TX
PostalCode: 752046224
CountryCode: US
TelephoneNumber: 2148209743
FaxNumber: 2148201490
Other Information
ProviderEnumerationDate: 07/07/2005
LastUpdateDate: 04/13/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GALINSKY
AuthorizedOfficialFirstName: WILLIAM
AuthorizedOfficialMiddleName: J
AuthorizedOfficialTitleorPosition: VP, GOVERNMENTAL FINANCE
AuthorizedOfficialTelephone: 2542159063
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QA1903X000710TXN Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
283XC2000X000710TXN HospitalsRehabilitation HospitalChildren
282NC2000X000710TXY HospitalsGeneral Acute Care HospitalChildren

ID Information
IDTypeStateIssuerDescription
09435730205TX MEDICAID


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