Healthcare Provider Details

I. General information

NPI: 1679542104
Provider Name (Legal Business Name): BEAUMONT PATHOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 11/06/2024
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 CALDER ST
BEAUMONT TX
77702-1809
US

IV. Provider business mailing address

PO BOX 421479
HOUSTON TX
77242-1479
US

V. Phone/Fax

Practice location:
  • Phone: 409-299-3214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES THOMAS MOLINA
Title or Position: AUTHORIZED OFFICIAL
Credential: MD, PHD
Phone: 409-236-1633