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General NPI Number Information
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NPI Number | 1831270156
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Entity Type | Organization
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Legal Business Name | BEAUMONT RADIOLOGY GROUP, LLP
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 4890 DOWLEN RD
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City | BEAUMONT
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State | TX
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Zip | 77708-4828
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Country | US
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Telephone | 409-838-4772
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Fax | 409-838-6134
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Provider Business Mailing Address
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Address Line | 4890 DOWLEN RD
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City | BEAUMONT
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State | TX
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Zip | 77708-4828
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Country | US
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Telephone | 409-838-4772
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Fax | 409-838-6134
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MRS. KATHI MANUEL
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Credential |
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Telephone | 409-838-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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