Healthcare Provider Details

I. General information

NPI: 1447575501
Provider Name (Legal Business Name): SPINDLETOP MHMR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 S 8TH ST BUILDING C
BEAUMONT TX
77701-7719
US

IV. Provider business mailing address

PO BOX 3846
BEAUMONT TX
77704-3846
US

V. Phone/Fax

Practice location:
  • Phone: 409-839-1000
  • Fax: 409-839-1066
Mailing address:
  • Phone: 409-839-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number142-142A
License Number StateTX

VIII. Authorized Official

Name: ANNIE J SMITH
Title or Position: REIMBURSEMENT MANAGER
Credential:
Phone: 409-839-1009