MEDICARE: SOUTHEAST TEXAS MEDICAL ASSOCIATES, LLP

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	207RR0500X	Rheumatology Physician
2	207W00000X	Ophthalmology Physician
3	261QM1300X	Multi-Specialty Clinic/Center	00R45W	TX
4	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
5	208000000X	Pediatrics Physician
6	207Q00000X	Family Medicine Physician

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	:	1922001312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST TEXAS MEDICAL ASSOCIATES, LLP

Provider Business Mailing Address
First Line	:	2929 CALDER ST
Second Line	:	SUITE 100
City	:	BEAUMONT
State	:	TX
Zip	:	77702-1845
Country	:	US
Telephone Number	:	409-833-9797
Fax Number	:	409-654-6886

Provider Business Practice Location Address
First Line	:	2929 CALDER ST
Second Line	:	STE 100
City	:	BEAUMONT
State	:	TX
Zip	:	77702-1841
Country	:	US
Telephone Number	:	409-833-9797
Fax Number	:	409-654-6906

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. JAMES L. HOLLY
Credential	:	M.D.
Telephone Number	:	409-833-9797

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/26/2016

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