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General NPI Number Information
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NPI Number | 1760275945
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Entity Type | Organization
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Legal Business Name | PCA SETX LLC
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 4347 PHELAN BLVD STE 101
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City | BEAUMONT
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State | TX
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Zip | 77707-2159
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Country | US
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Telephone | 409-498-1258
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Fax |
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Provider Business Mailing Address
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Address Line | 17400 FRIO DR
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City | BEAUMONT
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State | TX
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Zip | 77713-4300
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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 | BILLING MANAGER
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Name | MRS. SABRINA DAVIS
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Credential |
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Telephone | 409-207-4941
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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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