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General NPI Number Information
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NPI Number | 1811010457
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Entity Type | Organization
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Legal Business Name | SOUTHEAST TEXAS BARIATRIC CENTER, LLC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3050 LIBERTY ST
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City | BEAUMONT
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State | TX
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Zip | 77702-1801
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Country | US
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Telephone | 409-832-0092
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Fax | 409-923-1909
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Provider Business Mailing Address
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Address Line | 3050 LIBERTY ST
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City | BEAUMONT
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State | TX
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Zip | 77702-1801
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Country | US
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Telephone | 409-832-0092
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Fax | 409-923-1909
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Authorized Official
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Title or Position | ASC ADMINISTRATOR
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Name | MS. TAMARA RENE ANDERUD
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Credential | RN, BSN, CNOR
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Telephone | 409-839-5678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | PENDING
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License Number State | TX
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