Basic Information
| Provider Information | |||||||||
| NPI: | 1497755839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYLOR ALL SAINTS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848108 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148206710 | ||||||||
| FaxNumber: | 2148207950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761044110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179221957 | ||||||||
| FaxNumber: | 8179276226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | SANBORN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8179221854 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | 000363 | TX | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 273R00000X | 000363 | TX | Y | Hospital Units | Psychiatric Unit |
No ID Information.