MEDICARE: BIOTRONICS KIDNEY CENTER OF BEAUMONT, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	007139	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000HH069Y	OTHER	TX	BC BS TEXAS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003920356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIOTRONICS KIDNEY CENTER OF BEAUMONT, INC

Provider Business Mailing Address
First Line	:	PO BOX 7464
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77726-7464
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 MARTIN LUTHER KING JR DR #B
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-9000
Country	:	US
Telephone Number	:	409-886-7714
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	ELLEN M LEE
Credential	:
Telephone Number	:	409-892-1003

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	08/28/2012

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