MEDICARE: CITY OF PORT ARTHUR

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	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518157122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF PORT ARTHUR

Provider Business Mailing Address
First Line	:	449 AUSTIN AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-5802
Country	:	US
Telephone Number	:	409-983-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	449 AUSTIN AVE
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-5802
Country	:	US
Telephone Number	:	409-983-8800
Fax Number	:

Authorized Official
Title or Position	:	HEALTH AUTHORITY
Name	:	WILLIAM D GEORGE
Credential	:	MD
Telephone Number	:	409-983-8832

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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Directions to “CITY OF PORT ARTHUR ” Practice Location

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