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General NPI Number Information
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NPI Number | 1275928673
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Entity Type | Organization
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Legal Business Name | FANNETT MEDICAL CENTER
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 15321 HIGHWAY 124
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City | BEAUMONT
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State | TX
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Zip | 77705-9127
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Country | US
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Telephone | 409-794-2314
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 GRAYSON LN
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City | BEAUMONT
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State | TX
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Zip | 77713-4158
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Country | US
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Telephone | 409-201-2994
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | DR. ROGELIO MENDOZA
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Credential | M.D.
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Telephone | 409-794-2314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP127771
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License Number State | TX
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