Healthcare Provider Details

I. General information

NPI: 1124225776
Provider Name (Legal Business Name): BEAUMONT BONE & JOINT INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 LAUREL ST
BEAUMONT TX
77707-2216
US

IV. Provider business mailing address

3650 LAUREL ST
BEAUMONT TX
77707-2216
US

V. Phone/Fax

Practice location:
  • Phone: 409-838-0346
  • Fax:
Mailing address:
  • Phone: 409-838-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number000363
License Number StateTX

VIII. Authorized Official

Name: MR. DUANE N HILL
Title or Position: ADMINISTRATOR
Credential:
Phone: 409-838-0346