Provider Demographics
NPI:1871522714
Name:BAYLOR UNIVERSITY
Entity type:Organization
Organization Name:BAYLOR UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPORTS MEDICINE
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, LAT
Authorized Official - Phone:254-710-1021
Mailing Address - Street 1:150 BEAR RUN
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-1267
Mailing Address - Country:US
Mailing Address - Phone:254-710-1021
Mailing Address - Fax:254-710-4307
Practice Address - Street 1:150 BEAR RUN
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1267
Practice Address - Country:US
Practice Address - Phone:254-710-1021
Practice Address - Fax:254-710-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT05522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty