Healthcare Provider Details

I. General information

NPI: 1710308358
Provider Name (Legal Business Name): BEAUMONT SPINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2013
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 POINTE PKWY
BEAUMONT TX
77706-2000
US

IV. Provider business mailing address

3820 POINTE PKWY
BEAUMONT TX
77706-2000
US

V. Phone/Fax

Practice location:
  • Phone: 409-767-8221
  • Fax: 409-785-4200
Mailing address:
  • Phone: 409-767-8221
  • Fax: 409-785-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUANITTA FRANCIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-203-1645