Provider Demographics
NPI:1003920356
Name:BIOTRONICS KIDNEY CENTER OF BEAUMONT, INC
Entity Type:Organization
Organization Name:BIOTRONICS KIDNEY CENTER OF BEAUMONT, INC
Other - Org Name:BIOTRONICS KIDNEY CENTER OF ORANGE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-892-1003
Mailing Address - Street 1:PO BOX 7464
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-7464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 MARTIN LUTHER KING JR DR #B
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-9000
Practice Address - Country:US
Practice Address - Phone:409-886-7714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007139261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000HH069YOtherBC BS TEXAS
TX127317903Medicaid
TX127317901Medicaid
TX127317903Medicaid
TX127317901Medicaid