Provider Demographics
NPI:1144523861
Name:BAYCITY CLINIC INC
Entity type:Organization
Organization Name:BAYCITY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-323-9931
Mailing Address - Street 1:3406 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-7110
Mailing Address - Country:US
Mailing Address - Phone:979-323-9931
Mailing Address - Fax:979-323-9971
Practice Address - Street 1:3406 AVENUE F
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-7110
Practice Address - Country:US
Practice Address - Phone:979-323-9931
Practice Address - Fax:979-323-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0527261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty