MEDICARE: PORT ARTHUR SURGICAL ASSOCIATION

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	174400000X	Specialist

General Provider Information

NPI Number	:	1871610212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT ARTHUR SURGICAL ASSOCIATION

Provider Business Mailing Address
First Line	:	3820 HIGHWAY 365
Second Line	:	SUITE 200
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7543
Country	:	US
Telephone Number	:	409-721-5150
Fax Number	:	409-721-6102

Provider Business Practice Location Address
First Line	:	3820 HIGHWAY 365
Second Line	:	SUITE 200
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-7543
Country	:	US
Telephone Number	:	409-721-5150
Fax Number	:	409-721-6102

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN ALLEN SCHMIDT
Credential	:	M.D.
Telephone Number	:	409-721-5150

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/07/2010

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