Provider Demographics
NPI:1114006749
Name:THE MEDICAL CENTER OF SOUTHEAST TEXAS LP
Entity Type:Organization
Organization Name:THE MEDICAL CENTER OF SOUTHEAST TEXAS LP
Other - Org Name:THE MEDICAL CENTER OF SOUTHEAST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-724-7389
Mailing Address - Street 1:2555 JIMMY JOHNSON BLVD
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2007
Mailing Address - Country:US
Mailing Address - Phone:409-724-7389
Mailing Address - Fax:409-853-5910
Practice Address - Street 1:2555 JIMMY JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2007
Practice Address - Country:US
Practice Address - Phone:409-724-7389
Practice Address - Fax:409-853-5910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL CENTER OF SOUTHEAST TEXAS LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
45T518Medicare Oscar/Certification