Provider Demographics
NPI:1093744187
Name:BAPTIST HOSPITALS OF SOUTHEAST TEXAS
Entity Type:Organization
Organization Name:BAPTIST HOSPITALS OF SOUTHEAST TEXAS
Other - Org Name:MEMORIAL HERMANN BAPTIST BEAUMONT HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:PARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-212-5012
Mailing Address - Street 1:P O BOX 974599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-4599
Mailing Address - Country:US
Mailing Address - Phone:409-212-6149
Mailing Address - Fax:409-212-6063
Practice Address - Street 1:3080 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4606
Practice Address - Country:US
Practice Address - Phone:409-212-6149
Practice Address - Fax:409-212-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000389282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094148602Medicaid
TX094148601Medicaid
TX094148602OtherAMERIGROUP
TX450346OtherWORKERSCOMP
TXHH0450OtherBLUE CROSS BLUE SHIELD TX
TX500012OtherMHHNP
TX1731242Medicaid
TXHH0450OtherBLUE CROSS BLUE SHIELD TX
TX094148601Medicaid