Healthcare Provider Details

I. General information

NPI: 1588815252
Provider Name (Legal Business Name): SOUTHEAST TEXAS ASSISTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17782 FM 365 RD
BEAUMONT TX
77705-9164
US

IV. Provider business mailing address

17782 FM 365 RD
BEAUMONT TX
77705-9164
US

V. Phone/Fax

Practice location:
  • Phone: 409-794-9068
  • Fax:
Mailing address:
  • Phone: 409-794-9068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number677903
License Number StateTX

VIII. Authorized Official

Name: MRS. CHARITY RENEE HEIN
Title or Position: RNFA
Credential: RN, CNOR, RNFA
Phone: 409-794-9068