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General NPI Number Information
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NPI Number | 1710233226
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Entity Type | Organization
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Legal Business Name | FIRST ASCENT MEDICAL OF EAST TEXAS, PA
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 09/03/2012
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Provider Practice Location Address
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Address Line | 2830 CALDER ST
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City | BEAUMONT
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State | TX
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Zip | 77702-1809
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Country | US
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Telephone | 409-455-1071
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Fax | 409-232-0574
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Provider Business Mailing Address
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Address Line | 7950 SILVERLEAF ST
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City | BEAUMONT
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State | TX
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Zip | 77707-3637
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Country | US
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Telephone | 409-455-1071
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Fax | 409-232-0574
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN JOSEPH MUNROE
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Credential | M.D.
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Telephone | 409-455-1071
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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 | M7456
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License Number State | TX
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