Healthcare Provider Details

I. General information

NPI: 1760275945
Provider Name (Legal Business Name): PCA SETX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 PHELAN BLVD STE 101
BEAUMONT TX
77707-2159
US

IV. Provider business mailing address

17400 FRIO DR
BEAUMONT TX
77713-4300
US

V. Phone/Fax

Practice location:
  • Phone: 409-498-1258
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SABRINA DAVIS
Title or Position: BILLING MANAGER
Credential:
Phone: 409-207-4941