Provider Demographics
NPI:1164430906
Name:BEAUMONT INTERNAL MEDICINE & GERIATRIC ASSOC.
Entity Type:Organization
Organization Name:BEAUMONT INTERNAL MEDICINE & GERIATRIC ASSOC.
Other - Org Name:GEORGE E THOMAS & ASSOC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTOS
Authorized Official - Middle Name:MARCELO
Authorized Official - Last Name:SOBERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-898-2994
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:P-5200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1501
Mailing Address - Country:US
Mailing Address - Phone:409-898-2994
Mailing Address - Fax:409-899-5542
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:P-5200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1501
Practice Address - Country:US
Practice Address - Phone:409-898-2994
Practice Address - Fax:409-899-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093730201Medicaid
TXK608Medicare ID - Type UnspecifiedGROUP NUMBER