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General NPI Number Information
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NPI Number | 1619463536
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Entity Type | Organization
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Legal Business Name | CARE FOR PA
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 324 N 23RD ST
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City | BEAUMONT
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State | TX
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Zip | 77707
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Country | US
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Telephone | 409-839-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 324 N 23RD ST
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City | BEAUMONT
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State | TX
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Zip | 77707-2241
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Country | US
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Telephone | 409-839-4600
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING PERSONAL
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Name | MS. JESSICA R EVANS
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Credential |
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Telephone | 281-930-5182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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