Healthcare Provider Details

I. General information

NPI: 1447315437
Provider Name (Legal Business Name): USN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6085 GARNER RD
BEAUMONT TX
77708-4507
US

IV. Provider business mailing address

6085 GARNER RD
BEAUMONT TX
77708-4507
US

V. Phone/Fax

Practice location:
  • Phone: 409-898-8511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANK WESTON THOMPSON
Title or Position: INDEPENDENT DUTY CORPSMAN
Credential:
Phone: 619-519-3056