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General NPI Number Information
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NPI Number | 1457378333
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Entity Type | Organization
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Legal Business Name | BEAUMONT SURGICAL AFFILIATES, LTD
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 3560 COLLEGE ST
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City | BEAUMONT
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State | TX
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Zip | 77701
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Country | US
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Telephone | 409-835-7070
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Fax | 409-835-6111
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Provider Business Mailing Address
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Address Line | 3560 COLLEGE ST
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City | BEAUMONT
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State | TX
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Zip | 77701-4614
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Country | US
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Telephone | 409-835-7070
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Fax | 409-835-6111
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | PETER BLACH
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Credential |
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Telephone | 713-343-0832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 000384
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License Number State | TX
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