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General NPI Number Information
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NPI Number | 1639591480
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Entity Type | Organization
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Legal Business Name | CHS TEXAS MEDICAL, P.A.
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Dates
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Enumeration Date | 01/14/2014
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 11357 HIGHWAY 10 SW SMITH RD
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City | BEAUMONT
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State | TX
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Zip | 77705
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Country | US
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Telephone | 409-794-5253
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 MARYLAND WAY STE 200
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City | BRENTWOOD
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State | TN
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Zip | 37027-4973
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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 | EXECUTIVE VP
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Name | STUART CLARK
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Credential |
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Telephone | 703-760-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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