Basic Information
| Provider Information | |||||||||
| NPI: | 1750380507 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAYLOR MEDICAL CENTER AT WAXAHACHIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844597 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752844597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148206710 | ||||||||
| FaxNumber: | 2148207950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 W JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | WAXAHACHIE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751652231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729238056 | ||||||||
| FaxNumber: | 9729237096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TURNER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4698434004 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 000285 | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 3825810001 | 01 | TX | DME # | OTHER |