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General NPI Number Information
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NPI Number | 1710970066
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Entity Type | Organization
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Legal Business Name | SOUTHEAST TEXAS MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 2929 CALDER ST SUITE 100
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City | BEAUMONT
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State | TX
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Zip | 77702-1845
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Country | US
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Telephone | 409-233-9797
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Fax | 409-839-3174
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Provider Business Mailing Address
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Address Line | 2929 CALDER ST SUITE 100
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City | BEAUMONT
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State | TX
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Zip | 77702-1845
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Country | US
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Telephone | 409-833-9797
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Fax | 409-839-3174
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MR. RICHARD BRYANT
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Credential | RN
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Telephone | 409-833-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | R25266
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License Number State | TX
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