Provider Demographics
NPI:1093819393
Name:BAPTIST HOSPITALS OF SOUTHEAST TEXAS
Entity Type:Organization
Organization Name:BAPTIST HOSPITALS OF SOUTHEAST TEXAS
Other - Org Name:MEMORIAL HERMANN BAPTIST ORANGE 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 1:608 STRICKLAND DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-4717
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:2006-09-08
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000121273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========0002OtherCHAMPUS REHAB
TX45T005Medicare Oscar/Certification