=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194548073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HSA PORT ARTHUR, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2024
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2555 JIMMY JOHNSON BLVD
-----------------------------------------------------
City | PORT ARTHUR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77640-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-724-7389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 N BRAND BLVD STE 1200
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91203-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPUTY GENERAL COUNSEL
-----------------------------------------------------
Name | AIMEE GILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-666-0602
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------