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General NPI Number Information
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NPI Number | 1003920356
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Entity Type | Organization
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Legal Business Name | BIOTRONICS KIDNEY CENTER OF BEAUMONT, INC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 08/28/2012
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Provider Practice Location Address
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Address Line | 1301 MARTIN LUTHER KING JR DR #B
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City | ORANGE
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State | TX
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Zip | 77630-9000
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Country | US
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Telephone | 409-886-7714
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7464
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City | BEAUMONT
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State | TX
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Zip | 77726-7464
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | ELLEN M LEE
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Credential |
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Telephone | 409-892-1003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 007139
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License Number State | TX
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