MEDICARE: JEFFERSON COUNTY PUBLIC HEALTH DEPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1588318638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON COUNTY PUBLIC HEALTH DEPT

Provider Business Mailing Address
First Line	:	1295 PEARL ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-3642
Country	:	US
Telephone Number	:	409-839-2307
Fax Number	:	409-839-2302

Provider Business Practice Location Address
First Line	:	1295 PEARL ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-3642
Country	:	US
Telephone Number	:	409-839-2307
Fax Number	:	409-839-2302

Authorized Official
Title or Position	:	DIRECTOR/DOCTOR
Name	:	DR. EZEA D EDE
Credential	:	MD
Telephone Number	:	409-835-8530

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	02/08/2022

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Directions to “JEFFERSON COUNTY PUBLIC HEALTH DEPT ” Practice Location

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